This is an individual assignment. Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation to accompany the teaching plan and present the information to your community. Select Long-term care facility for delivery of the presentation:

 

Community Teaching Experience

 

 

Students must submit this form as part of the assignment submission.

 

Student Name:__________________						Course Section & Faculty Name:_____________________________
Date of Presentation:_____________
Provider Information
Provider Name :
Last								First			M.I.
Credentials:						Title:
(i.e., MS, RN, etc.)
Organization:
Phone Number:
E-mail Address:
Student Presentation Information
Type of Presentation:
PowerPoint Presentation				Pamphlet Presentation				Audio Presentation		Poster Presentation
D
Provider Acknowledgement

 

 

 

I __________________________acknowledge that ____________________________

(Provider Name)                                                         (Student Name)

 

has requested approval to participate in a community teaching experience at the location listed on this form. The organization / agency does not endorse the university or the student however, the teaching plan developed by the student is considered appropriate and of benefit to the community of interest.

 

 

 

 

 

______________________________                                                _________________

Provider Signature                                                                                 Date Signed