Basic BSN Readmission Application
Instructions: Please read all information carefully and fill out the form completely (MUST BE TYPED).
Application materials for readmission must be received by November 15 for the following
spring semester or February 1 for the following fall semester.
(Postmarks by the deadline are not considered as meeting the application deadline.)
Mail Materials to:
University of Wyoming
Fay W. Whitney School of Nursing
ATTN: Basic BSN Readmission Application
Dept 3065
1000 E University Ave
Laramie, WY 82071
Hand Deliver Materials to:
OR
Debbie Shoefelt
University of Wyoming
Fay W. Whitney School of Nursing
Health Sciences Center, Room 335
(307) 766-4292
basicbsn@uwyo.edu or shoefelt@uwyo.edu
This readmission application is only for use by students that were previously formally admitted to
the nursing major component of the BSN Program (Basic BSN) and that have gone out-of-sequence
(e.g. due to failure/unsatisfactory in any nursing course and/or pharmacology, withdrawal for
personal reasons) . Readmission is on a space available basis.
READMISSION POLICY
As a student seeking readmission potential to the Basic BSN option, refer to the School of Nursing Readmission
Policy identified within the Basic BSN Handbook (current year) to learn more about the complete process. The
handbook is accessible on the nursing website within the Handbooks link located in sidebar menu.
LETTER OF SUPPORT FOR READMISSION
As identified within the Readmission Policy, present in writing along with this application an explanation of the
circumstances that led to withdrawal or caused the unsatisfactory performance and a proposal addressing the
deficiencies and/or causes for the withdrawal which will facilitate satisfactory completion of the course.
SCHOOL OF NURSING POLICIES/REQUIREMENTS
Students seeking readmission to the nursing major component of the program must be in contact with Debbie
Shoefelt (basicbsn@uwyo.edu or shoefelt@uwyo.edu) to determine what information needs to be updated with
the FWWSON according to the School of Nursing Basic BSN Policies & Requirements with regard to CPR,
immunizations, malpractice insurance, etc. Students must be current on all policies & requirements in order to be
eligible for clinical upon readmission.
Basic BSN Readmission Application, 12/2012
Page 1 of 2
University of Wyoming / College of Health Sciences
Dept 3065 / 1000 E University Ave / Laramie WY 82071 / (307) 766-4292
Basic BSN Readmission Application
Instructions: Please read all information carefully and fill out the form completely (MUST BE TYPED).
PERSONAL DATA
Last Name
Full Legal
Name
First Name
Last Name
Other names used if
different from above.
UW ID Number (W-ID #)
Middle Name
First Name
Social Security Number
Middle Name
Date of Birth (YYYY/MM/DD)
Gender (place X in box)
Female
Marital Status
Ethnic Background (voluntary information)
Single
American Indian or Alaska Native
Date of Birth (YYYY/MM/DD) Asian American or Pacific Islander
Married
Black or African American
Gender (place X in box)
Other
Email
Address
Chicano or Hispanic
White or Caucasian
UW Email Address
Non-UW Email Address
Street/Box
Current
Mailing
Address
City
State
Zip Code
State
Zip Code
Street/Box
Permanent
Mailing
Address
City
Phone
Numbers
Male
Cell Phone
(include Area Code)
Current Phone
(include Area Code)
Semester/Year seeking readmission:
Permanent Phone
(include Area Code)
Fall Semester
Work Phone
(include Area Code)
Spring Semester
(please indicate the year under the appropriate semester)
As noted in the Readmission Policy in the Basic BSN Handbook, the Dean
shall appoint a panel composed of one faculty member of the student’s
choice and two from the faculty at large (please indicate choice):
Faculty Member of Student’s Choice
Honesty Statement: The University of Wyoming is built upon a strong foundation of integrity, respect, and trust. All members of
the University community have a responsibility to be honest and the right to expect honesty from others. Any form of academic
dishonesty is unacceptable to our community and will not be tolerated.
By signing below, I certify… that I am aware and understand the Honesty Statement mentioned above; that any attempt on my
part to falsify answers or exclude pertinent data is cause for rejection of my application and/or dismissal from the program; and
that all information I have provided is true/accurate to the best of my knowledge.
Signature
Date
UW is an affirmative action/equal opportunity educational institution
Basic BSN Readmission Application, 12/2012
Page 2 of 2
University of Wyoming / College of Health Sciences
Dept 3065 / 1000 E University Ave / Laramie WY 82071 / (307) 766-4292