Nursing Readmission Request Form

NURSING DIVISION READMISSION REQUEST

(To be completed by the student)
*Required Fields


	*First Name:
	*Last Name:
	*Phone:
	*Email Address:
	*Student ID Number:
	*Program Admitted To:

*Reason for readmission request:

Unsuccessful in

*Course:

*Semester:

*Year:

*Fast Forward:

Need for interruption during

*Semester:

*Year:

*Fast Forward:

Explain Reason for Interruption:

Please select the Semester and Fast Forward you would like to return?

*Semester:

*Fast Forward:

*Year:

I am using the Readmission Policy published in the 2005-2006 Student Nurses Handbook.
I am using the Readmission Policy as outlined in the Readmission Policy Change dated October 13, 2005.

* Program Level.

A grade of W, D, F, or U in a clinical nursing course is considered an unsuccessful attempt. Courses for the Practical Nursing Program must be completed within 26 months of admission to the Nursing Program. Courses for the Associate Degree Program must be completed within 36 months of admission to the Nursing Program. Courses for the LPN to ADN Program must be completed within 18 months of admission to the Nursing Program. Students unable to complete the specific Nursing Program within the allowed time limits are required to re-enter at the beginning of the program.