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Reinstatement/Petition for Admissions Form
Name
Former Name (if different):
Account
EMPLID:
VCCS UserName:
Address
Telephone
Home
Cel
Current Academic Status
Suspension Effective Date
Dismissal Effective Date
(requires separation from PHCC for at least a year and exceptional circumstances)
Dismissal/Suspended from another college.
Explain the circumstances which contributed to your status.
Explain how these conditions have changed and why you feel you should be readmitted.
How many hours a week will you be working?
How many credit do you plan to take?
Sign the line above with Mouse or Finger