UAFS Carolyn McKelvey Moore School of Nursing Exit Survey/Withdrawal

Email Address

UAFS ID

First Name

Middle Name

Last Name

Birthdate

Race (select all that apply):

Legal Sex

Female

Male

Semester Withdrawing

Academic Status at Withdrawal

Level in Program

Other Career Choice?

Explain Other:

Please Check all support services you used:

Please specify transfer school:

Comments:

Student must supply documentation of how they have addressed the problems identified above as part of the readmission procedure. Documentation will be supplied to the Readmission Committee for review.

Students may access Readmission Criteria and Procedure in the Student Handbook online.

In place of your signature, please type your full legal name

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UAFS Carolyn McKelvey Moore School of Nursing Exit Survey/Withdrawal