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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

You MUST click Keep this signature







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