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Readmission Application WorksheetName: Y#:Course(s) applying for:Semester applying for: Last semester attended:Strategies for Success (Include 2):PLEASE READ CAREFULLY AND SIGN BELOWI certify that I have read and understand the information on this application and it is complete and accurate to the best of myknowledge. I understand that omitting, withholding or giving false information may make me ineligible for readmission andenrollment. I release from all liability or damages those persons, agencies, or organizations who may furnish information inconnection with my application for readmission. If accepted, I agree to read and abide by all school and Department policiesand procedures.Signature: Date:Advisor Signature: Date:

Appendix DNursing Program Readmission ApplicationSemester applying for (i.e. Spring/Fall 2022)Course(s):Please print or typeNameYavapai College “Y” NumberList any previous names while in the Yavapai College Nursing ProgramMailing Address (Street, P.O. Box):City:PhoneState:Zip:YC Student e-mailOn which campus are you applying for re-admission?PrescottVerde Valley*Either*Once a student is re-admitted to the nursing program and is assigned to a campus, the student isexpected to complete the program on that campus and is responsible for housing andtransportation.What was the last academic semester that you attended the Nursing Program, (i.e., Fall 2021)? :Which Program Semester are you requesting re-admission to (1st, 2nd, 3rd, 4th)?If applicable, list other colleges from which you are transferring courses and course completion dates.Transfer credits MUST be evaluated for equivalency by Yavapai College.ADVISOR SIGNATURE: DATE:

The Readmission Application may be hand-delivered to the Nursing Office, mailed to address below oremailed.Mail to: Yavapai College Nursing Department1100 East Sheldon Street, YC Box6017Prescott, AZ 86301Phone:Toll Free:E-mail928-776-22471-800-922-6787, ext.2247keryn.lafferty@yc.eduPlease, remember to enclose your receipt for the Readmission application and sign your portion of theRe-Admission Agreement. If you are accepted for readmission, a copy executed by the NursingProgram Director will be forwarded to you to confirm your acceptance.Please note: The Nursing Program Readmission Application is part of the Nursing Student Handbook.Please refer to the handbook for the Readmission Policy and procedure for Readmission.

Appendix EReadmission Agreement and AcceptanceI understand that no more than two attempts are allowed for any nursingcourse. An attempt is defined as any enrollment in the course even if I, the student, selfwithdraw or I am administratively withdrawn prior to course completion. I understand thatthis is my second and final enrollment in this/these course(s) and no additional enrollment(s)in this/these course(s) will be allowed or offered, regardless of the final course outcome.I am enrolling for the following course(s):.I understand that I will not be given another opportunity to continue in the programwithout a successful completion grade of “C” or above with regard to this courseenrollment.Printed Name:Signature:Date:Accepted:Dr. Marylou Mercado, Ed.D, MSN, RN, CNE

READMISSION POLICYI. POLICY STATEMENTYavapai College Nursing Program supports the readmission of qualified students with onewithdrawal or failure. No readmission is guaranteed. The maximal amount of time studentscan be out of the program is two semesters. After two semesters students must apply as anew program student applicant to be considered for admission.Data and reapplication materials will be reviewed by Nursing Program Instructional Support Staff, Director ofNursing, and Student Advising. The following data points criteria will be used for decision making in studentplacement:1.2.3.4.5.6.Current GPACourse Percentage GradeProgram Entrance GPAOne course failureTwo or more course failuresPoint system score: application entrance score (includes ATI TEAS score up to 50% of points) Point system score is the application entrance score for admission into the Nursing Program- up to 1000points possible.II. POLICYA. Definitionsi. Readmission: enrolling in the same semester course(s) from which thestudent had a withdrawal or failure. No readmission is guaranteed. Thereadmission process is available for students in every semester of theNursing Program.ii. Failure: course failure in one or more courses within one semester.iii. Withdrawal: course withdrawal from one or more courses within onesemester. A course withdrawal after the halfway point of the nursingcourse(s) when a student is not meeting course competencies at thetime of withdrawal is considered a course failure.iv. Good standing: maintaining a passing grade (“C” or / 78% or “S”) in allnursing core courses at the time of withdrawal; maintaining studentconduct in accordance with the Nursing Program Student Handbook.Readmission Policy Updated 12.03.21

ELIGIBILITY2. Generally, if the student has had more than one withdrawal orone failure or any combination of the two for any reason thestudent is considered to be out of the Nursing Program. TheDirector of Nursing may consider emergency circumstances whenapplying this eligibility requirement.3. A student may be granted ONE readmission per program enrollment ifthere is space available after considering all first-time applicants andthe student has no previous readmissions. The location where aspace may open is not guaranteed.4. The Director of Nursing reserves the right to deny a request forreadmission if the student was dismissed for issues relating toacademic integrity, unsafe patient care, inappropriate conduct,violation of Student Handbook provisions, or dismissal from a collegeor clinical agency.5. The Director of Nursing reserves the right to approve anadmission or readmission for a student in good standing who hasto withdraw for military deployment or an unexpectedcatastrophic event (death of an immediate family member orsevere injury or illness).6. Students who seek readmission due to illness or injury will needto submit a physician’s release to meet the essential functions ofthe Nursing Program. Director of Nursing will review thedocumentation before a determination for readmission can begranted.7. When space is not available in the semester a student applies for,the application may be considered for the following semester. Thesame criteria applies for readmission consideration.8. All students must meet current Health and Safety requirements.9. A clinical skills refresher check off will be required for students accepted forreadmission who did not complete clinical in the current semester, or haveReadmission Policy Updated 12.03.21

been out of clinical for one semester or more before advancing to the nextclinical course. Students will be required to perform the nursing skillscompetency check off at a satisfactory level.10. The clinical skills refresher check off will be scheduled by the student.The student is responsible for making the check off appointment withthe Faculty/Instructor and should contact the Nursing Program Officeto initiate this process. The Faculty/Instructor will approve and finalizethe date for check off. Practice times prior to the check off may bescheduled in collaboration with the Faculty/Instructor.11. The check off is part of the readmission plan. Satisfactory completion isrequired prior to advancing to the next clinical course in the Nursing Program.Proof of completion must be submitted to the Nursing Program office.12. Students requesting readmission must:a. Meet with a Yavapai College academic advisor.b. Complete the Readmission Application Worksheet. The worksheetshould include course(s) needed and semester applying for;actions taken, to be taken, or changes in situation that wouldoptimize the student’s success.c. Update the immunization tracker in Castle Branch prior toapplication submission. Other Castle Branch items includingbackground check and random drug screening may be required ifthe student has been out of the Nursing Program for onesemester or more. Payment for Castle Branch requirements willbe the responsibility of the student.d. Submit required application documents for readmission to theadministrative office of the Nursing Program.13.III.Students granted readmission must enroll at the nextcourse offering. Readmission is on a seat available basis.No readmission is guaranteed.PROCEDUREA. The student desiring readmission must follow the steps in the ReadmissionPolicy as outlinedbelow:1. Meet with an academic advisor regarding readmission process.2. Completed Readmission Application Form and ReadmissionApplication Worksheet dated and signed by academic advisor.3. Readmission Agreement signed and dated by student.Readmission Policy Updated 12.03.21

4. Complete Castle Branch To Do List Summary Report incompliance with program requirements. Submit report withreadmission application.5. Receipt for 50 Readmission fee (payable at college’s cashieroffice or online at www.yc.edu/nursing).6. Submit complete readmission application packet to theNursing Department up to two business days after thecourse completes.B. After review of the Application for Readmission materials, andenrollment availability data, the Director of Nursing will notify students ofthe final decision.C. The student will receive notification of the readmission decision from theDirector of Nursing. Notification will be emailed to the student’s YCScholar email and a formal letter sent to the address of record.D. Re-admitted students who repeat courses in which they previouslyachieved a passing grade must again achieve a passing grade in samecourse(s) to progress in the programfollowing re-entry.E. Appeals to any of the above practices must be made to the Director ofNursing whose decision will be final.F. Incomplete readmission applications will not be processed. Please makecopies of documents prior tosubmitting the application (we do notprovide copy service).G. Readmission application materials are to be received by the nursing officefrom the student on the first Tuesday after the regular semester ends by4:00 PM: no exceptions will be given or made.Readmission Policy Updated 12.03.21

Mail to: Yavapai College Nursing Department Phone: 928-776-2247 1100 East Sheldon Street, YC Box 6017 Toll Free: 1-800-922-6787, ext. . Yavapai College Nursing Program supports the readmission of qualified students with one withdrawal or failure. No readmission is guaranteed. The maximal amount of time students