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CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions
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CON Request for Waiver of Faculty Immunizations or CPR Requirements (view source)
Revision as of 13:41, October 7, 2019
, October 7, 2019no edit summary
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<td colspan="2" valign="top">Related documents:<br /><div style="margin-left:3em; line-height:1.2;"> | <td colspan="2" valign="top">Related documents:<br /><div style="margin-left:3em; line-height:1.2;">4.2.12</div></td> | ||
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<p style="margin-bottom:150px; max-width:70em !important;">I, ________________________________________________, request a waiver of requirements for the following immunization(s) and or CPR | <p style="margin-bottom:150px; max-width:70em !important;">I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):</p> | ||
<p style="margin-bottom:150px;">for the following reason(s):</p> | <p style="margin-bottom:150px;">for the following reason(s) (ex. allergy):</p> | ||
<table style="max-width:70em !important;" width="100%" cellspacing="0" cellpadding="0" border="0"> | <table style="max-width:70em !important;" width="100%" cellspacing="0" cellpadding="0" border="0"> | ||
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<tr><td colspan="3"> </td></tr> | <tr><td colspan="3"> </td></tr> | ||
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<td>_______________________________________________</td> | <td>_______________________________________________</td> | ||
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<td>Date</td> | <td>Date</td> | ||
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<tr><td colspan="3">Submit completed/signed form to conrecords@unmc.edu</td></tr> | |||
<tr><td colspan="3"> </td></tr> | <tr><td colspan="3"> </td></tr> | ||
<tr><td colspan="3">Note: For recurring requirements, form should be submitted each time requirements comes due.</td></tr> | |||
<tr><td colspan="3"> </td></tr> | <tr><td colspan="3"> </td></tr> | ||
</table> | </table> | ||