Contact and Acknowledgment

Instructions:

We need to have your contact information and the acknowledgment that you have completed this distance learning orientation for our records. Please respond to each item in the area below by clicking in each box and either typing in the requested information or clicking on the appropriate choice.

Thank you.

Please acknowledge your full understanding of what is required of you, now that you have completed this distance education orientation, by clicking on the box that corresponds to yes. Your Contact Information and Acknowledgment Form will be placed in your file as a verification of your required attendance in the nursing distance education orientation.

Acknowledgment