ReStart Petition Form

Please complete the ReStart Petition Form if you wish to have a session(s) removed from your permanent acadaemic record. Refer to the policy to determine eligibility. The ReStart option is not guaranteed. It may be granted only after careful consideration and review of your academic record by the Associate Dean for Academic Programs.

First Name

Middle Initial

Last Name

Previous Last Name(s), if applicable

University ID Number

Current Address

City

State

Zip

Phone Number

Email Address

Last Year and Term Enrolled at UI

Current Enrolled

Yes

If no, re-entry session:

Sessions to be removed

I understand:

1) All courses and credits taken during the chosen session will be removed from consideration for GPA and degree requirements.

2) Degree requirements met during the dropped session(s) will have to be repeated in order to fulfill the degree requirement.

3) I have not graduated from The University of Iowa.

Please acknowledge

Yes

Student Signature

Date