Description
lease have the representative of the nonprofit organization sign the “Community Teaching Project – Interview Acknowledgment Form” following the interview. This form is to demonstrate that the interview with the representative was completed.The “Community Teaching Project – Interview Acknowledgment Form” is a clinical document that is necessary to meet clinical requirements for this course. Therefore, this form must be submitted with the representative’s handwritten signature. A typed, electronic signature will not be accepted.You are not required to submit this assignment to LopesWrite.
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NRS-425 Community Teaching Project – Interview Acknowledgment Form
Students must submit this form in the digital classroom in Topic 4.
Student Name:
Course Section and Faculty Name:
Date of Interview:
Representative Information
Representative Name :
Last
Credentials:
First
M.I.
Title:
(i.e., MS, RN)
Organization:
Phone Number:
Email Address:
D
Provider Acknowledgement
I ___________________________ acknowledge that ____________________________
(Representative’s Name)
(Student’s Name)
has interviewed me and received feedback about the above-mentioned organization and
community for their Community Teaching Project. The organization/agency does not endorse
the university or the student; however, the teaching plan developed by the student is
considered appropriate and of benefit to the community of interest.
Representative’s Signature (must be handwritten)
Date Signed
© 2023. Grand Canyon University. All Rights Reserved.
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