Re-Entry Form

Students in the 8 week online program who would like to re-enroll in classes after withdrawing from all classes for two consecutive blocks or more must write a two-three page letter stating their intent and reason for returning.  The letter must also contain information describing their prior enrollment situation and why they withdrew from classes.  In addition to the body of the letter, students are required to prepare a re-entry timeline.  Students will not be allowed to re-enroll until the letter has been approved by the student’s Re-Entry Counselor and his/her supervisor.

Please fill out the form below and we will contact you.

Re-Entry Information Complete the form below or call: 866-932-4692
Contact Info Changed:	Yes No
First Name:
Last Name:
Phone Number:
Current Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennesse Texas Utah Vermont Virgin Islands Virginia Washington West Virgina Wisconsin Wyoming Other
Zip Code:
E-mail:
Program of Interest:	Associate of Arts Computer Networking Criminal Justice Human Services Health Care Administration Logistics and Transportation Management
Projected re-entry date:	3/19/2013 4/16/2013 5/14/2013 6/11/2013 7/9/2013 8/6/2013 9/3/2013 10/1/2013 10/29/2013 11/26/2013