Request for Readmission 
Admissions and Records
P. O. Box 80  Weyers Cave, VA 24486
(540) 234-9261/1-888-750-2722/ TDD 234-0848

This form requires a signature and cannot be transmitted electronically. Please complete the application, print, sign, and return to the above address.   
Date
Last Term Attended
Current Curriculum
Name
Address
City, State, Zip Code
Phone
Social Security #

I request to be readmitted to Blue Ridge Community College in the
curriculum beginning
semester, 20.  I recognize that in order to remain in college I will be required to maintain at least a 2.00 average during the semester following reinstatement and must maintain at least a 1.5 grade point average in each subsequent semester of attendance.  I understand that I must answer all questions below.

Signature of student

1.  List specific reasons why your grades are low.



2.  What changes in your circumstances have occurred to insure a reasonable chance of your grades improving?



3. Give specific reasons for requesting the curriculum you listed above.



For BRCC Use:
Approved
Disapproved

Comments:


Counselor
Date