Assignment 5A
TaniAlexis
nrs-427v-rs-communityteachingexperienceform.doc
Community Teaching Experience
Students must submit this form as part of the assignment submission.
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Course Section & Faculty Name: Grand Canyon University_&____ _______________________ |
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Date of Presentation _ 03/09/2017 ___________ |
NRS-427 VN Community and Public Health. |
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Provider Information |
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Provider Name : |
Milian Jennifer |
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Last |
First |
M.I. |
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Credentials: |
RN |
Title: |
Case Manager |
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(i.e., MS, RN, etc.) |
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Organization: Miami Health Community Program |
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Phone Number:305 468 7984 |
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E-mail Address: | |||
/Student Presentation Information |
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Type of Presentation: |
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FORMCHECKBOX PowerPoint Presentation |
x FORMCHECKBOX Pamphlet Presentation |
FORMCHECKBOX Audio Presentation |
FORMCHECKBOX Poster Presentation |
D
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Provider Acknowledgement |
I _Jennifer Milian____________________acknowledge that _ Tania Gonzalez Diaz___________________________
(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.
____Jennifer Milian ________________________ _03/09/17_______________
Provider Signature Date Signed
