CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 58: | Line 58: | ||
<table style="max-width:70em !important; text-align:center" width="100%" cellspacing="0" cellpadding="0" border="0"> | <table style="max-width:70em !important; text-align:center" width="100%" cellspacing="0" cellpadding="0" border="0"> | ||
<tr> | <tr> | ||
<td> | <td>_____________________________________</td> | ||
<td width="75px"> </td> | <td width="75px"> </td> | ||
<td>_______________________________</td> | <td>_______________________________</td> | ||
</tr> | |||
<tr> | |||
<td>Faculty Signature</td> | |||
<td width="75px"> </td> | |||
<td>Date</td> | |||
</tr> | </tr> | ||
</table> | </table> | ||
Revision as of 09:43, October 3, 2013
| Home | Appendices |
| UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING |
||
| Request for Waiver of Faculty Immunizations or CPR Requirements(Subsection 4.2.12 in Resource Manual) | Subsection: Appendix M | |
| Section - Information | Originating Date: October, 2003 | |
| Responsible Reviewing Agency: Executive Council Faculty Coordinating Council |
|
|
| J:/RESOURCE MANUAL/Table of Contents College of Nursing Resource Manual | ||
I, ________________________________________________, request a waiver of requirements for the following immunization(s) and or CPR, and include a signed statement from my primary care provider if for medical reasons:
for the following reason(s):
| _____________________________________ | _______________________________ | |
| Faculty Signature | Date |