CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions
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<td align="center" colspan="2"><big>'''UNIVERSITY OF NEBRASKA MEDICAL CENTER<br />COLLEGE OF NURSING'''</big></td> | |||
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<td width="60%"><big>'''Request for Waiver of Faculty Immunizations or CPR Requirements'''</big></td> | |||
<td valign="top" width="40%"><big>Subsection: '''Appendix M'''</big></td> | |||
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<td width="60%">Section - Appendices</td> | |||
<td width="40%">Originating Date: October 2003</td> | |||
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<td valign="top" width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Executive Council<br />Faculty Coordinating Council</div></td> | |||
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<td>Revised: [[CON Request for Waiver of Faculty Immunizations or CPR Requirements version February 2008|February 2008]]<br />Reviewed: [[CON Request for Waiver of Faculty Immunications or CPR Requirements version May 2016|May 2016]]<br />Revised: March 2018</td> | |||
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<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 (please list):</p> | |||
<p style="margin-bottom:150px;">for the following reason(s) (ex. allergy):</p> | |||
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<td>_______________________________________________</td> | |||
<td width="75px"> </td> | |||
<td>_______________________________</td> | |||
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<td>Faculty Signature</td> | |||
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<td>Date</td> | |||
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<td>Department Chair/Division Assistant Dean Signature</td> | |||
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<td>Date</td> | |||
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<tr><td colspan="3">Submit completed/signed form to conrecords@unmc.edu</td></tr> | |||
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<tr><td colspan="3">Note: For recurring requirements, form should be submitted each time requirements comes due.</td></tr> | |||
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Latest revision as of 13:42, October 7, 2019
| Home | Appendices |
| UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING |
||
| Request for Waiver of Faculty Immunizations or CPR Requirements | Subsection: Appendix M | |
| Section - Appendices | Originating Date: October 2003 | |
| Responsible Reviewing Agency: Executive Council Faculty Coordinating Council |
|
|
| Related documents: 4.2.12 |
||
I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):
for the following reason(s) (ex. allergy):
| _______________________________________________ | _______________________________ | |
| Faculty Signature | Date | |
| Submit completed/signed form to conrecords@unmc.edu | ||
| Note: For recurring requirements, form should be submitted each time requirements comes due. | ||