LIC Volunteer Approval Form

 

This form is used to approve volunteer opportunities not offered through the SNA.  This form must be filled out completely and turned in at least 2 weeks before the event.  The LIC committee will review submitted forms.  Responses will be sent by email.

 

Event Guidelines:

·        Related to health care or health promotion

·        Not an event for class credit or something you get paid to do

o       Ex. Required LEI visits

 

Student Name: ___________________________   Class: _________________

 

Student Email: ___________________________________________________           

 

Event Name: _____________________________  Event Date: ____________

 

Contact Person: ___________________________    Phone: ______________

 

Description:  What is the event for? How will you be participating? How is the event related to health promotion, health care, or nursing?

 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Do not write below this line

 

LIC Committee Only

 

Approved: ____Yes ____No

 

Approved By: __________________________________

 

Date: _____________