timeline for making profit: Investors will need an indication of when they expect some return on their investment so you need to provide some reasonable timelines of when that will be

Community Teaching Experience

Students must submit this form as part of the assignment submission.

Student Name:__________________	Course Section & Faculty Name:_____________________________
Date of Presentation:_____________
Provider Information
Provider Name :
Last	First	M.I.
Credentials:		Title:
(i.e., MS, RN, etc.)
Organization:
Phone Number:
E-mail Address:
Student Presentation Information
Type of Presentation:
FORMCHECKBOX PowerPoint Presentation	FORMCHECKBOX Pamphlet Presentation	FORMCHECKBOX Audio Presentation	FORMCHECKBOX Poster Presentation
D
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