Readmission Application




In order to make a request for readmission, you must complete this application and turn into the
Nursing Department.
It will be reviewed by the Learner Success Committee and approved or denied.
Do NOT register for courses until you have been notified to do so.
Applications are due within 1 (one) day of final grades being posted in Angel/Talon.
Checklist:
 Step One: Fill out the readmission application.

Step Two: Develop a detailed plan of academic readiness.
o The plan must:
 Contain an introduction, body, and closing paragraph.
 Include the following:
 Description of the reason(s) you left the program
 Analysis of factors that lead to this outcome
 Goals to be accomplished during your remaining time at Kirkwood Community College
Nursing Program
 Specific plan of action to meet your goal(s)

Step Three: Sign and date. If approved, the plan of academic readiness will become a contract for the student
to follow throughout the remainder of the nursing program.

Step Four: Turn this application in person to the nursing department, Linn hall 2172.
Kirkwood Community College
Department of Nursing
6301 Kirkwood Blvd. SW
Cedar Rapids IA 52404
319-398-5563
Step One: Student Information
Readmission Level
Are you an LPN transfer?: Yes
No
Time: Day
Evening/Weekend
Last semester you were enrolled in classes: (ex: Spring 2015)
Readmission level: (What level do you need to repeat?)
Semester: (The semester you will retake courses. ex: Fall 2015)
Student Information
Date:
K#:
Student Name:
Street Address:
City, State, Zip:
Phone Number (Cell):
Kirkwood Email Address:
@student.kirkwood.edu
Previous Re-Admission
Have you been readmitted before?
Yes (If yes, complete the following steps on this page.)
No (If no, continue to next page.)
If yes, please indicate the readmission level:
Foundations I
Foundations II
Specific populations
Concepts
Advanced Concepts
If yes, please give any other information about your previous readmission for the readmission committee.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please attach a separate, typewritten Word document to provide additional information if needed.
Step Two: Detailed Plan of Academic Readiness
Hint: The plan must be typewritten and contain an introduction, body, and closing paragraph. The plan must
include the following: Description of the reason(s) you left the program, analysis of factors that led to this
outcome, goals to be accomplished during your remaining time at Kirkwood Community College Nursing
Program, and a specific plan of action to meet your goal(s). Copy and paste into the box. Sign and date below.
Step Three: Agreement and Signature:
By submitting this application, I agree to comply with all applicable policies & procedures including
participation in the Nursing Mentorship Program. I understand that my application information will be
reviewed by the Readmission Committee and a decision will be made accordingly. I understand that I may be
readmitted into a different time (day, evening/weekend) based on availability. I understand I will be notified of
approval/denial 1 week prior to the start of class via my Kirkwood Email.
Sign________________________________________________________ Date:______________________