CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions
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<td width="60%"><big>'''Request for Waiver of Faculty Immunizations or CPR Requirements'''</big> | <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> | <td valign="top" width="40%"><big>Subsection: '''Appendix M'''</big></td> | ||
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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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<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> | ||
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Latest revision as of 13:42, October 7, 2019
| Home | Appendices |
| UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING |
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| 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 |
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| Related documents: 4.2.12 |
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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. | ||