NLU PA Student Immunization and Health Insurance Policy

NLU PA Director of Didactic Education Verification

I verify that the student's immunization compliance status has been reviewed and documented for the purpose of determining compliance with applicable NLU PA Program requirements.

Name: ___________________________________________________

Signature: _______________________________________________

Date Signed: _____________________________________________

NLU PA Director of Clinical Education Verification

I verify that the student's immunization compliance status has been reviewed and documented for the purpose of determining compliance with applicable NLU PA Program and clinical education requirements.

Name: ___________________________________________________

Signature: _______________________________________________

Date Signed: _____________________________________________

SECTION III. CLINICAL PHASE/SCPE IMMUNIZATION AND SCREENING VERIFICATION

CHECK ONE:

☐ The following required immunizations and health-screening requirements were checked prior to the student's placement in the clinical phase of the NLU PA Program Supervised Clinical Practice Experiences (SCPEs) and are in compliance with all applicable affiliated clinical site requirements.