Clinton Community College

Readmission Application

Readmission for returning students

Re-Admission Application (if you have been academically dismissed)

Reinstatement of Financial Aid Eligibility (if you have lost your financial aid, students are eligible for only one reinstatement of financial aid in his/her college career)

Renaissance program (if you have not taken a course at CCC for five years, students may apply for this program after completing 12 hours of courses with a GPA of 2.0 or higher)

Re-admission requested for the following semester: *

Re-admission requested to attend: *

Name First/MI/Last *

Address *

City, State, Zip *

Last four digits of Social Security Number *

Home Telephone Number *

E-Mail:

Former Name:

Date of Birth *

Have you been convicted of a felony? *

Have you been dismissed from any college, including Clinton, for academic misconduct? (e.g. Cheating, Plagiarism) *

If Yes what College and when:

Please list any colleges you have attended since leaving Clinton. (if applicable)

If you have not attended colleges, please explain your activities since you were last enrolled at Clinton.

If this appeal is granted, I understand that I may be eligible for readmission to Clinton Community College for the following semester, and agree to the terms selected by the Admission Review Committee. I further understand that if my financial aid is reinstated that this is the only waiver I will be granted during my entiere undergraduate enrollment. *

Students who are re-admitted after being academically dismissed from Clinton agree to meet with a member of our Counseling and Advisement staff (562-4199) to discuss and monitor the criteria below for your return. This program will be tailored to meet your needs as defined by an advisor in the Counseling and Advisement Office. This may include but not be limited to: WEEKLY TUTORING SESSION/S, REGULARLY VERIFIED CLASS ATTENDANCE, LIMITED COURSE REGISTRATION

Describe the circumstances that prevented you from maintaining the required level of satisfactory academic progress. Attach third party documentation if applicable. Examples of third party documentation include physician's statement, accident paperwork, death certificates/notices of family members, etc. Attach addiitional documentation if necessary. (FAX 518-562-4159 Attn: Student Services)