Registrar: Dismissal Appeal

Students must submit this form by May 30th for fall 2025 readmission.
Personal Information
Last Name * Required
First Name * Required
SUNY Poly ID Number (U#) * Required
Email * Required
Street Address * Required
City, State, Zip Code * Required
Telephone * Required
Do you plan to live on campus in the residence halls if approved to return to SUNY Poly? * Required
- Yes
- No
Academic Information
Degree Level * Required
- Undergraduate
- Graduate
What Academic Program (Major) Are You Requesting Readmission to? * Required
Last Term Attended (Term and Year, e.g., "Fall 2022") * Required
Have you attended another college/university since you last attended SUNY Poly? * Required
- Yes
- No
If you have attended another college/university, what is the name of that institution? (You will need to submit an official transcript.)
Judicial Information
Have you ever been dismissed from another college/university for disciplinary reasons? * Required
- Yes
- No
To be considered for possible readmission to SUNY Polytechnic Institute, you must explain what factors led to your academic dismissal AND what factors will be different next semester
In your own words, please describe the factors that led to your academic dismissal: * Required
Your specific plan to improve is: * Required
Affirmation of Identity * Required
- I affirm that I am the student listed on this form.
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Students must submit this form by May 30th for fall 2025 readmission.