Notice to All Buncombe County Internship or Student Teaching Applicants
A completed NC Health Examination Certificate must be submitted with your internship or
student teaching application for your request to be forwarded for consideration by
Buncombe County School District. The Office of Field Experiences is not set up to store
HIPPA information, but as a courtesy, your Health Examination Certificate will be
collected and forwarded to Buncombe County. To enable OFE to assist you in this manner,
please complete, sign, and date the statement below.
I, __________________________________________, understand that I am submitting my
Health Examination Certificate to the WCU Office of Field Experiences for the sole
purpose of facilitating consideration of my request to intern or student teach in Buncombe
County. I understand that this form will be forwarded to Buncombe County, and that a
copy WILL NOT be stored in OFE. It is my responsibility to make and keep my own
copies of all documents for my records.
______________________________________________
Applicant Signature
_________________________
Date
Office of Field Experiences | 228 Killian | Cullowhee, NC 28723 | 828.227.7314 tel | 828.227.7610 fax