NRS 427V RS CommunityTeachingExperienceForm
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communityteachingexperienceform
Community Teaching Experience
Students must submit this form as part of the assignment submission.
Student Name: Stella Ndukwe Course Section & Faculty Name: Lotus Clinic Date of
Presentation: _____
Provider Information Provider Name :
Last First M.I. Credentials:
Title:
(i.e., MS, RN, etc.)
Organization:
Phone Number:
E-mail Address:
Student Presentation Information Type of Presentation: PowerPoint Presentation
Pamphlet Presentation Audio Presentation Poster Presentation D
Provider Acknowledgement