college of nursing policy handbookRevised 2019

to the class adviser/s.

1x1
picture

Date:

I, , BSN Level ,
(student’s name) (Yr/Section)

residing at ,
(postal address)

do hereby declare; that I fully understand and will abide by the

rules and regulations set for the student - nurse practice.

Student’s signature over printed name

Parent’s/guardian’s signature over printed name

Date:

Contact Numbers:
Residence landline:
Cellular phone :
Email address :

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