CON Request for Waiver of Faculty Immunizations or CPR Requirements version February 2008
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| UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING |
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| 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 |
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| 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 | |
| _______________________________________________ | _______________________________ | |
| Department Chair/Division Assistant Dean Signature | Date | |