NLU PA Student Immunization and Health Insurance Policy

I acknowledge that the NLU PA Program has reviewed my immunization and health-screening compliance status for the purpose of determining my eligibility for participation in the clinical phase of the curriculum and Supervised Clinical Practice Experiences.

I understand that individual clinical affiliates may have additional health, immunization, screening, or safety requirements.

Student Name: ___________________________________________

Student Signature: ________________________________________

Date Signed: _____________________________________________

NLU PA Director of Didactic Education Verification

I verify that the student's applicable NLU PA Program immunization and screening compliance requirements have been reviewed before the student's transition to the clinical phase of the curriculum.

Name: ___________________________________________________

Signature: _______________________________________________

Date Signed: _____________________________________________

NLU PA Director of Clinical Education Verification

I verify that the student's applicable immunization and screening compliance requirements have been reviewed before placement in Supervised Clinical Practice Experiences and that applicable affiliated clinical-site requirements have been addressed.

Name: ___________________________________________________

Signature: _______________________________________________

Date Signed: _____________________________________________