NLU_PA_Didactic_Year_Student_Handbook (Full) updated

NLU PA Program — Didactic Year Handbook

Student Signature / Date (I acknowledge understanding of and agree to the plan set forth above): _______________________________________________________

Professionalism Competency Evaluation Form

Student Name: _______________________________________________________

Course / Activity: _______________________________________________________

Evaluator: _______________________________________________________

Rating (Scale: 1–5): _______________________________________________________

Comments: _______________________________________________________

Evaluator Signature / Date: _______________________________________________________

Occupational Exposure / Incident Report Form

Students who experience an occupational injury, illness, or exposure while participating in Program- sponsored educational or clinical activities must complete the National Louis University Incident Report Form, available at:

https://cm.maxient.com/reportingform.php?NationalLouisUniv&layout_id=1

For assistance completing this form, contact dos@nl.edu. Use the Issues Resolution Form for general complaints or the Academic Appeals Form for academic concerns; see the Occupational Exposure, Injury, Illness, and Incident Reporting Policy (Appendix E) for the complete reporting procedure.

Health Screening and Immunization Compliance Verification Form

ARC-PA Standard A3.18. Record Classification: Confidential Student Educational/Compliance Record. Purpose: Verification of required immunization and health-screening compliance for participation in the NLU PA Program and Supervised Clinical Practice Experiences (SCPEs). This form is intended to document compliance with required immunization and health-screening requirements; it is not intended to serve as a comprehensive student medical record. Access is limited to authorized NLU PA Program and University personnel with a legitimate responsibility to verify compliance.

Section I. Student Identification

Student Name: _______________________________________________________

NLU Student ID Number: _______________________________________________________

Cohort/Graduation Year: _______________________________________________________

Date of Matriculation: _______________________________________________________

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