Have you attended UNC-Pembroke as a RALC student (Regional Alternative Licensure Center).
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.
Date of Birth
Preferred Email Contact
Check one of the following:
When do you plan to return to UNCP?
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.
Name of School
Current Teaching Assignment
Have you attended UNC Pembroke before?
If you answer yes, please list date previously attended and the name used at the time.
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 Returning students that fail to demonstrate compliance will be cancelled from their classes and withdrawn from the university.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.
Have you been convicted of a crime?
Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere, or an Alford plea, or have you received a deferred prosecution or prayer for judgment continued, to a criminal charge?
Have you otherwise accepted responsibility for the commission of a crime?
Do you have any criminal charges pending against you?
Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by or university?
If you have ever served in the military, did you receive any type of discharge other than and honorable discharge?
If you answered "yes" to any of the six questions above, please explain the circumstances below.
I understand that I will not be eligible for licensure recommendation from UNC Pembroke with the Regional Licensure Plan of Study.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.
I UNDERSTAND THAT WITHHOLDING INFORMATION
You must check one of the boxes to the right in order to be considered a readmit student. This will serve the same purpose as your written signature.