Please fill out this form with great thought and care. When completed, make an appointment to meet with your academic advisor or your academic standards officer to discuss your plan.
_____Fall Semester _____Spring Semester 20___
Your name _____________________________
Banner ID @____________________________
Permanent address ________________________________________________
Permanent telephone ______________________________________________
Local address _________________________________________________
Local telephone ____________________________________
Your IUP e-mail address __________________________________
Cumulative Grade Point Average (CGPA) __________ GPA Hours __________
Academic advisor’s name ____________________________________________
Course ____________________________ Grade _______ Repeat D F
I realize that if I do not make progress toward academic good standing, I will be dismissed at the end of this semester.
Student signature_________________________________ Date____________________