NRS-425 Community Teaching Project – Interview Acknowledgment Form
NRS-425 Community Teaching Project – Interview Acknowledgment Form
Students must submit this form in the digital classroom in Topic 4.
Student Name: |
Course Section and Faculty Name: |
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Date of Interview: |
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Representative Information |
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| Representative Name : | |||||||||||||||
| Last | First | M.I. | |||||||||||||
| Credentials: | Title: | ||||||||||||||
| (i.e., MS, RN) | |||||||||||||||
| Organization: | |||||||||||||||
| Phone Number: | |||||||||||||||
| Email Address: | |||||||||||||||
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Provider Acknowledgement |
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| I ___________________________ acknowledge that ____________________________ | |||||||||||||||
| (Representative’s Name) | (Student’s Name) | ||||||||||||||
| has interviewed me and received feedback about the above-mentioned organization and community for their Community Teaching Project. 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. | |||||||||||||||
| Representative’s Signature (must be handwritten) | Date Signed | ||||||||||||||
