LIC Discrepancy Form; to be Reviewed by the SNA Board

 

Name:

NUR Class:
SNA Member: _____ Yes _____No

SNA Status: (Board Member, Delegate, SNA member, Non SNA Member)

 

Stated Problem with LIC points (to be filled out by student):

____________________________________________________

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____________________________________________________

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____________________________________________________

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____________________________________________________

____________________________________________________

____________________________________________________

 

 

 Reconciliation Plan of LIC Points (to be filled out by SNA Board):

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

 

 

Community Wellness Signature:  __________________________

 

Board Member Signature: _______________________________

 

LIC Discrepancy Form; to be Reviewed by the SNA Faculty Advisor

 

Name:

NUR Class:
SNA Member: _____ Yes _____No

SNA Status: (Board Member, Delegate, SNA member, Non SNA Member)

 

Stated Problem with LIC points (to be filled out by student):

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

 

 

 

 Reconciliation Plan of LIC Points (to be filled out by SNA Faculty Advisor):

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

 

 

Community Wellness Signature: ____________________________

 

SNA Faculty Advisor Signature: ____________________________

Last modified 01.25.10