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:
(i.e., MS, RN, etc.)
Student Presentation Information Type of Presentation: PowerPoint Presentation Pamphlet Presentation Audio Presentation Poster Presentation D
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...
Excerpt from file: CommunityTeachingExperience Studentsmustsubmitthisformaspartoftheassignmentsubmission. StudentName:__________________ DateofPresentation:_____________ CourseSection&FacultyName:_____________________________ ProviderInformation ProviderName: Last Credentials: (i.e.,MS,RN,etc.) First M.I. Title:
Filesize: < 2 MB
Print Length: 2 Pages/Slides
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