Statement of Understanding
Student Name:
Program:
College:
As a student of this program, I agree to the rules, regulations, policies and procedures as stated below.
- The program requires a period of assigned, guided clinical experiences either in the college or other appropriate facility in the community.
- For educational purposes and practice on “live” models, I consent in allowing other students to practice non-invasive procedures on me as I will practice these same procedures on them under the guidance and direct supervision of my instructor. The nature and educational objectives of these procedures have been fully explained to me. No guarantee or assurance has been given by anyone as to any problem that might be incurred as a result of these procedures.
- I have read and agree to comply with the Drug and Alcohol Policy of both the college and the facility.
- These clinical experiences are assigned by the instructor for their educational value and thus no payment (wages) will be earned or expected.
- It is understood I will be a student within the clinical facilities that affiliate with my college and will conduct myself accordingly. All required and published personnel policies, standards, philosophy, and procedures of these agencies will be followed: I also agree to obtain all health screenings and immunizations required by the affiliating agency.
- I have read and agree to adhere to the college’s policies, rules, and regulations related to the program for which I am applying.
- I understand the information regarding a patient or former patient is confidential and is to be used only for clinical purposes within an educational setting.
- I understand the educational experiences and knowledge gained during the program do not entitle me to a job; however, if all educational objectives and licensure requirements are successfully attained, I will be qualified for a job in this occupation.
- I understand any action on my part inconsistent with the above understandings may result in suspension of training.
- It is understood that I am liable for my own medical and hospitalization expenses.
- I understand that I will be accountable for my own actions; therefore, I will carry adequate limited professional liability insurance during the clinical phase of the program.
- I have read, understand each statement, and agree to abide by the above.
To be signed by legal guardian if applicant is a minor:
Student Signature:
Date:
As the legal guardian of the student named above, I agree to the above conditions.
