Texas Tech University Health Sciences Center School of Nursing by hxtMEE65

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									 Texas Tech University Health Sciences Center School of Nursing
                       RN-BSN program

                 Return From Leave Form

Name ___________________________________________
Address _________________________________________
Social Security # ________________ Phone (H)____________
Phone (w) ___________________ Cell ___________________
Personal e-mail _________________________________________

Courses completed ______________________________________
Circle the semester I would like to return to the RN-BSN program
fall,         spring,    summer                    _____(yr)
For the following reason _________________________________
______________________________________________________


I understand that this Return From Leave form must be completed
two months before the beginning of the semester (July for Fall
semester, November for Spring semester, and April for summer semester).
I understand that if I have been gone from the RN-BSN program
for more than one semester I will have to re-apply to the Texas
Tech University Health Sciences Center School of Nursing RN-
BSN program.

___________________________                         __________________
Signature of student                                Date signed


Send completed and signed form to:
RN-BSN Program Office
Texas Tech University Health Sciences Center School of Nursing
3601 4th Street
Lubbock, TX 79430      806 743-4842 or 800 493-3954 Fax 806 743-1648

								
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