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Health Sciences Nursing Programs
Wait List Withdrawal Notification

I am requesting that my name be withdrawn from the Wait List.  I understand that with the submission of this form my name will be removed from the list.  In the future, should I decide that I would like to enroll in the program, I will have to submit another application during the specified application filing period and begin the wait process over again.

Nursing Program   
 * Full Name:  
 * Address:  
 * City:  
 * State:  
 * Zip Code:  
 * Phone No.  
 Email Address:  
Reason for Withdrawal: