Request for Readmission or Reinstatement Form

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Request for Readmission or Reinstatement Form

Instructions:

This form is to be completed in full and submitted by the student to the program coordinator to request readmission or reinstatement into a nursing program following dismissal or a leave of absence of less than a year. A student with a leave of absence of one year or more must reapply for readmission. Refer to the School of Nursing Handbook for the Readmission and Reinstatement policies and process.

Request for Readmission or Reinstatement

Please complete the following information.

I understand that I must immediately initiate the readmission or reinstatement process upon notification of non-progression within the program. (Required) Format: Name Initials

Student ID Number: (Required) Format: Student ID Number

Student’s First Name: (Required) Format: John (Please include your first name)

Student’s Last Name: (Required) (Please include your last name)

Semester and year requesting readmission or reinstatement: (Required)

Students (Area Code) and Phone Number (Required)

UTRGV Email: (Required) (The results of your request will be emailed to you.)

Undergraduate Program:

Indicate the name of your Graduate program:

Where you plan to attend: (Required)

Semester and year completed: (Required)

I will schedule a meeting immediately upon notification of non-progression with School of Nursing Program Coordinator, and Academic Advisor from the Academic Advising Center (Required) Format: Name Initials (Possible points of discussion are factors that influenced the failure, drop, withdrawal, or leave of absence and to obtain recommendations and/or referrals to assist with overcoming any barriers and challenges to success. )

Program Coordinator’s Name: (Required)

Program Coordinator Appt. Date: (Required)

Academic Advisor’s Name: (Required)

Academic Advising Appt Date.: (Required) (Review: “Student Performance Assessment Form” and “Student Success Action Plan”)

I understand that I must update all program requirements (immunizations, CPR, insurance, and criminal background check) before returning to the nursing program to the program administrative assistant. (Required) (Name Initials)

Student Signature & Agreement: (Required) (By signing, I certify that all the above information and statements are true to the best of my knowledge. I understand that omitting, withholding, or giving false information may make me ineligible for readmission and enrollment. I understand that submission of this form is part of my formal request to be readmitted or reinstated into the nursing program, and submission of this form does not guarantee readmission or reinstatement. I understand that requests are granted on a space-available basis. I understand that I will not be given another opportunity to continue in the nursing program without a successful completion with a grade of “C” in my remaining courses. )

Date: (Required) Format: mm/dd/yyyy

Required: Attach your readmission request letter (Address to your program coordinator in your letter.)

Which course title and number did you not progress in: (Required) (Include course title, number and section)

Who was your instructor for that course: (Required)

Contact Information

Undergraduate BSN Programs

University of Texas School of Nursing
1201 West University Drive
Edinburg, TX 78539-2909

Office: EHABE 2.201

For assistance with readmission or reinstatement, contact your assigned Undergraduate BSN Program Coordinator (Generic or 2nd Degree) by visiting:

Undergraduate BSN Program Coordinators page

Graduate College Programs

University of Texas School of Nursing
1201 West University Drive
Edinburg, TX 78539-2909

Office: EHABE 2.201

For assistance, contact your Graduate Program Director by visiting:

Graduate Program Director and Coordinators page

Request for Readmission or Reinstatement Form

Academic Programs Menu

Instructions:

Request for Readmission or Reinstatement

Contact Information

Undergraduate BSN Programs

Graduate College Programs

School of Nursing

Brownsville

Edinburg

Hours

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