Application for Re-Admission

Application for Re-Admission

Students who wish to return to the nursing program after a break in enrollment in nursing courses must complete the following information and submit this form to the Nursing Department Office in order to be considered for re-enrollment in nursing courses.

Students requesting re-admission will be expected to meet the academic standards for nursing students as detailed in the ASU catalog and will be accepted on a "space available" basis. This form must be received in the Nursing Department Office no later than three months prior to the desired re-enrollment date.

Darton College of Health Professions

Department of Nursing

K Building, Rm. J-210

2400 Gillionville Road

Albany, GA 31707

Telephone: 229-500-2389

Fax: 229-500-4894

Current Information

Last Name:*

Middle Name:

First Name:*

Ram ID Number:*

(ex. 900xxxxxx)

If previous enrollment was under a different name, please give name used at that time:

(First Name and Last Name)

Last class attended (NURS#):*

Last Semester Attended:*

Select

Last Year Attended:*

Select

Mailing Address:*

(Street and Number)

City:*

State:*

Select

Zip:*

Telephone Number:*

Phone

Re-Admission Information

I wish to be considered for re-admission to the nursing program beginning with the course, semester and track listed below:

Course Number NURS:*

Semester (for Re-Admission):*

Select

Year (for Re-Admission):*

Select

Signature:*

(Please type in your First and Last Name)

Today's Date:*

Personal Identifiable Information (PII) Notice:

All personal data and special categories of sensitive personal data collected or processed by Albany State University (ASU) must comply with the ASU Cybersecurity Program Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity:

https://www.usg.edu/policies

Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to:

LegalAffairs@asurams.edu

Otherwise, questions concerning GDPR can be forwarded to LegalAffairs@asurams.edu. Typing your name in the box below and submission of this application provides consent to and acknowledgment of the ASU Data Security and Privacy Policy.

Please check the box below to indicate that you have read and understood the PII policy above.

Personal Identifiable Information (PII) Consent:*

9/92 Rev. 1/97, 6/99, 6/03, 10/06, 09/07, 01/1 0, 2/18

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