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 at the beginning of each week. 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 for
- Example: Required visits with LEI client
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: ___________
