09 Jun Question NRS427 Concepts in Community and Public Health
Question
NRS427 Concepts in Community and Public Health
Week 5 Assignment
Community Teaching Experience Approval Form
Before presenting your “Community Teaching Plan: Community Presentation” to the community, seek approval from an agency administrator or representative. Upon receiving approval from the agency, submit the completed “Community Teaching Experience Approval Form.”
Community Teaching Experience
Students must submit this form as part of the assignment submission.
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Student Name:__________________ .4pt; width:329.2pt”>
Course Section & Faculty Name:_____________________________
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Date of Presentation:_____________
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Provider Information
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Provider Name :
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Last
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First
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M.I.
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Credentials:
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Title:
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(i.e., MS, RN, etc.)
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Organization:
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Phone Number:
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E-mail Address:
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Student Presentation Information
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Type of Presentation:
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PowerPoint Presentation
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Pamphlet Presentation
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Audio Presentation
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Poster Presentation
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D
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Provider Acknowledgement
I __________________________acknowledge that ____________________________
(Provider Name) (Student Name)
has requested approval to participate in a community teaching experience at the location listed on this form. The organization / agency does not endorse the university or the student however, the teaching plan developed by the student is considered appropriate and of benefit to the community of interest.
______________________________ _________________
Provider Signature Date Signed
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