STUDENT ORIENTATION CONFIRMATION
Name: ________________________________ School:_______________________________________
Facility: ________________________________Department(s)/Unit(s):___________________________
Beginning Date of Affiliation :_____________
Ending Date of Affiliation: _________________________
I affirm that I have read the Student Affiliation Orientation Handbook understand the content and have
successfully completed the post test with a score of 15/16 or greater. I have read the Confidentiality
Statement and the Technology Confidentiality Statement and fully understand its meaning and the
seriousness of failing to abide by the guidelines therein.
Student Signature: _____________________________________________Date: __________________
Parent/or Guardian Signature (if applicable):_________________________Date: __________________
Instructor Signature: ___________________________________________Date: __________________
Preceptor/Mentor/Sponsor/or Designee Signature: ____________________Date: __________________