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DACC Nursing Program Student Handbook 2012-2013APPENDIX – GASSOCIATE DEGREE NURSING PROGRAM CONTINUANCE_________________________________________________________________________________________________________Dona Ana Community College does not discriminate on the basis of race, color, creed, national origin, religion, age, gender, sexual orientation, politicalaffiliation, or physical disability.Please initial one:_____ I wish to continue in the Nursing Program for the ____________(semester) __________ (year) and repeat NURS_________ (course). I understand I am responsible for informing the Nursing Program Office of anychanges to my file including: additional course work, change of address, name, or contact informationetc._____ I do not wish to continue in the Associate Degree Nursing Program at this time and am aware I will have to gothrough the readmission process at a later date.This form must be received by the DACC Nursing Program Department no later than one weekafter final grades are posted.Please return form to:Or Fax:Dona Ana Community CollegeAttn: Associate Degree Nursing ProgramMSC 3DA. P.O. Box 30001Las Cruces, NM 88003-8001(575) 527-7765, Attn: Nursing ProgramOr In Person: Health & Public Services Building, Room 190Printed Name: ______________________________________Banner ID: _______________Signature: _________________________________________Date: ___________________For Official Use OnlyReceived By: _________________________Nursing Staff: ________________________Date Received: ______________Date Received: ______________55 | P a g e