The Gail & Richard Lumpkin School of Nursing (RN to BSN Program) Appeal Application

If you have received notification from the Director of the RN to BSN Program and have been removed from the program for withdrawals or failing a courses, please fill this out for consideration to be readmitted to the program.

Date Submitted Date Submitted * / MM / DD YYYY
Name Name * First Last
E-Number *
EIU Email *
Personal Email *
Phone Phone * - ### - ### ####
1st Course you made a withdrawal or failed *
Semester of the 1st Course *
2nd Course you made a withdrawal or failed *
Semester of the 2nd Course *
3rd Course you made a withdrawal or failed *
Semester of the 3rd Course *
Please give a explanation on why you should be readmitted to the RN to BSN Program. *
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.