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Regional Alternative Licensure Center Readmission Form

Directions:Please complete and click the "Submit" button.

If the answer is yes, please continue with this form. However, if the answer is no, contact the Licensure Office located in the School of Education, Room 101A.

Permanent Address

Local Address

Please give name, address and current assignment in the public school currently employed. However, if you are not currently employed in a public school, please indicate inserting N/A in the required fields.

All students must comply with the North Carolina immunization laws. Returning students that fail to demonstrate compliance will be cancelled from their classes and withdrawn from the university. Please contact UNC-Pembroke's Student Health Services

Campus Safety Questions
Your "yes" answer to one or more of the following questions will not necessarily preclude your being admitted. However, your failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw your admission, or to dismiss you after enrollment.
For the purpose of the following six questions, "crime" or "criminal charge" refers to any crime other than a traffic-related misdemeanor or an infraction. You must, however, include alcohol or drug offenses whether or not they are traffic related.
I understand that I will not be eligible for licensure recommendation from UNC Pembroke with the Regional Licensure Plan of Study.
I UNDERSTAND THAT WITHHOLDING INFORMATION requested in this application or giving false information may make me ineligible for admission to/or continuation at The University of North Carolina at Pembroke. With this in mind, I certify that the statements herein are correct and complete. I understand my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after enrollment.