Health Sciences Division
ADN Request for Re-enrollment

Provide all information requested on the form.

First Name:
Last Name:
ACC eID:
Mailing Address:
City:
State:
Zip Code:
Home Phone:
Email:
Course Number of last successfully completed course:
Site / Track of last course completed:
Date (semester/year) of the last course enrolled in:
Course Number for which re-enrollment is requested:
Semeseter for which re-enrollment is requested:
Reason for re-enrollment in course:
Site / Track requested for re-enrollment:
1: I understand that I am only allowed to re-enroll in a RNSG course one time. Yes
No
2: I understand that I am only allowed to re-enroll in a total of 11 semester hours in the ADN program. Yes
No
3: I understand that the deadlines for request to re-enroll in a course are: Spring (December 17th), Fall (June 5th), and Summer (May 5th). Yes
No
4: I understand that my request for re-enrollment will be ranked according to my priority rating (see ADN handbook) then by grade or standing in the course(s) at the time of withdrawal. Yes
No
5: I understand that the Admissions Committee will either approve or deny my request for re-enrollment based on my past performance in the ADN Program. Yes
No
6: I understand that if my request for re-enrollment is approved, the Admissions Committee can require additional course work, medication examination, or check-off as a condition of re-enrollment. Yes
No
7: I understand that if my request for re-enrollment is approved, registration in the course(s) is permitted only if space is available. Yes
No
8: I have read the re-admission policy as outlined here. Yes
No
9: I understand that I will receive notice as to whether or not space is available for re-enrollment by the Nursing Office one month prior to the start of the semester. Yes
No
10: I understand that I am not to register until I am given WRITTEN PERMISSION that space is avaiable for me. You will be dropped by the Nursing Department if you register before permission is given. Yes
No
Comments: