Verification of Student and Faculty Compliance for 2008 Required Training

Verification of Student and Faculty Compliance for

Spring, 2017 Required Training

By placing faculty and student names below, you are agreeing to the following:

·  All have reviewed the Faculty and Nursing Student Orientation Packet.

·  All have reviewed and signed the Mayo Confidentiality, Electronic Security Authorization Agreement, and HIPAA information forms.

·  All meet the immunization (including the influenza vaccine), health, insurance, and background check requirements outlined in the master clinical agreement.

·  Schools are responsible for collecting and maintaining required forms in the students’ files which may be audited by Mayo Clinic.

Please sign, and send to Grace Liu, Education Coordinator.

Thank you.

School: ______

Signed: ______Date: ______

Name of Faculty / Year in Program
Name of Student