Associate of Science in Nursing Program
Physical Address: 7500 Millhaven Rd., Monroe, LA 71203
Phone: (318) 345-9174
FAX: (318) 345-9573
Dear Applicant:
Thank you for re-applying to the Associate of Science in Nursing (ASN) program here at Louisiana Delta Community
College (LDCC). Below is a checklist to guide you in the re-application process.
PLEASE NOTE: INCOMPLETE APPLICATIONS MAY NOT BE CONSIDERED.
Please submit the following:

Completed LDCC ASN Student Re-Admission Application (included in this packet.)

Completed unofficial curriculum sheet/ degree audit (included in this packet.)

Unofficial copy of your transcript
o

Evidence of licensure
o

Is your cumulative GPA at or above 2.5? Yes____ No____
Are you a Licensed Practical Nurse? Yes ___ No___ (LPN transition applicants must provide two copies
of license verification obtained from the Louisiana State Board of Practical Nurses Examiners. Please visit
http://www.lsbpne.com/license_verification.phtml.)
Have you applied for re-admission before? Yes ____ No ____
Please note: A student may re-enter the ASN program one time. Applicants are considered only if there is space available
in the program. The decision on whether to accept a student is based on overall GPA, completion of required general
education courses, academic and class performance, attendance record, clinical evaluations and demonstrations of
previous competencies. Additional considerations include a thorough analysis of the applicant’s reasons for leaving and
any actions taken to enhance his/her success upon re-entry.
If the student’s coursework was interrupted for more than two consecutive regular semesters (12 months,) NURS courses
may have to be repeated.
Deliver your completed application packet with all additional information to Office 223.
Be sure to include this signed page in your packet. Questions may be directed to the Program Director at 318-345-9174 or
[email protected].
By signing below you verify that your application packet is complete.
Printed name: ____________________________________________
Signature: _______________________________________________
Date: ___________________________________________________
Re-Admission Application
(Please note: the deadline to re-apply is the 1st Monday in October for Spring entry and the 1 st Monday in April for Fall entry.)
Bastrop
Farmerville
Lake Providence
Monroe
Ruston
Tallulah
Member of Louisiana Community and Technical College System
West Monroe
Winnsboro
Associate of Science in Nursing Program
PERSONAL CONTACT INFORMATION:
Name: _____________________________________________________________________________________
First
Middle
Maiden
Last
Address: ____________________________________________________________________________________
Street
Apt. /Unit #
City
State
Zip
Phone: _____________________________________________________________________________________
Home
Cell
Other
Emergency Contact: ___________________Relationship to applicant: ________ Phone Number: ____________
Preferred E-Mail Address: _____________________Secondary E-Mail Address: ___________________________
DOB__________
AGE GROUP (Choose one) 17-20____
____
21-25____
26-30____
31-40____ 41-50____ 51-60____ 61+
OTHER INFORMATION:
I am applying to re-enter the: Traditional Program _____
LPN to RN Transition* _____
*LPN to RN transition applicants must provide a copy of license verification obtained from the Louisiana State Board of Practical Nurses Examiners
(http://www.lsbpne.com/license_verification.phtml).
I am applying to re-enter the nursing program: (Please circle one)
Level I
Level II
Level III
Level IV
Last Nursing Course enrolled in: Course Number: ______Course Name: _______________ Semester: ________Year: _______
Reason(s) for withdrawal/dismissal: (Please check all that apply)
Personal Reasons
___Scheduling Conflict
___Illness
___Financial Issues
___Child Care
___Employment
___Transportation
___Personal Reasons
___Other
Academic Reasons
___Instructor Issues in Classroom
___Schedule Overload
___Instructor Issues Online
___Excessive Unexcused Absences
___Insufficient Preparation for class
___Grades
___Improper Advising
___Other
Did you complete an Exit Interview when you left LDCC? Yes___ No___
Please explain what actions have been taken to ensure your success upon re-entry to the program: _________________________
______________________________________________________________________________________________________
_______________________________________________________________________________________________________
I certify that the statements in this application are true and complete to the best of my knowledge. I am aware that falsification of
information is basis for denying re-admission.
Student’s Signature_______________________________________________________
Date______________________
Program Director’s Signature: ______________________________________________
Date_______________________
Member of the Louisiana Community and Technical College System
Associate of Science in Nursing Program
Member of the Louisiana Community and Technical College System