ADN Readmission Form

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Health Sciences Division

Health Sciences Information and Admissions Office
Eastview Campus
Building 8000, Room 8356
3401 Webberville Road
Austin, TX 78702
Phone: 512.223-5700 or
toll-free 888.626-1697
E-mail:
healthsciences@austincc.edu

ADN Request for Readmission

Provide all information requested on the form.

First Name:
Last Name:
ACC ID#
Mailing Address:
City:
State:
Zip Code:
Home Phone:
Alternate Phone:
Email:
Date of Withdrawal (semester/year):
Reason for Withdrawal:
Request for readmission to the following course(s):
Requesting readmission for (semester/year):
Comments to Admissions Committee:
I understand that I am allowed only one readmission into the ADN Program.
Yes No
I understand that my request for readmission will be ranked according to my priority rating (see ADN Student Handbook) then by grade or standing in the course(s) at the time of withdrawal.
Yes No
I understand that the Admissions Committee will either approve or deny my request for readmission based on my past performance in the ADN Program.
Yes No
I understand that if my request for readmission is approved, the Admissions Committee can require additional course work or remediation as a condition of readmission.
Yes No
I understand that if my request for readmission is approved, registration in the course(s) is permitted only if space is available.
Yes No
I understand that the deadlines for readmission requests are: Spring (December 17th), Fall (June 5th), and Summer (May 5th).
Yes No
I understand that I will be contacted by the Nursing Admissions office one month prior to the start of the semester.
Yes No

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