_______________

Aldwin Gonzalez
Chief Nurse, North Genertal
Hospital

Dear Sir Gonzalez,

Greetings

I,_______________________________, would like to inform your good office that I will

go on OR volunteer on _____________ for the completion of my PRC requirements. In
line with this, I am aware that the university and the hospital will not be held liable for
whatever untoward incident that may happen to me during this duty. I can be reached
through this number: ________________

May your kindness grant this request consideration. Thank you!

Very respectfully yours,

___________________
Student

Noted by:

Mrs. Mary Angel Ygnacio

Record Adviser (MU 3rd Generation)

Mrs. Dolores M. Saldivia

Clinical Coordinator, CDU CN