NRS-425 Community Teaching Project: Teaching Acknowledgment Form
NRS-425 Community Teaching Project: Teaching Acknowledgment Form
This form acknowledges that the teaching presentation has been completed. Students must submit this form in the digital classroom in Topic 5.

Student Name:

Course Section and Faculty Name:

Date of Presentation:

ORDER A PAPER HERE

Representative Information

Representative Name :
 
 
 

 
Last
First
M.I.

Credentials:
 
Title:
 

 
(i.e., MS, RN)

Organization:
 

Phone Number:
 

Email Address:
 

Student Presentation Information

Type of Presentation:

PowerPoint presentation
Pamphlet presentation
Poster presentation
Infographic presentation

 Provider Acknowledgement

I ___________________________ acknowledge that ____________________________

 
(Representative’s Name)
(Student’s Name)

has participated in a community teaching experience at the organization listed on this form. 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.  NRS-425-RS-T5-TeachingAcknowledgmentForm

 
 
 

Representative’s Signature (must be handwritten)
 
Date Signed

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