NRS 428 Community Teaching Experience Approval Form

Community Teaching Experience Approval Form

 NRS 428 Community Teaching Experience Approval Form

Before presenting your “Community Teaching Plan: Community Presentation” to the community, seek approval from an agency administrator or representative. Upon receiving approval from the agency, submit the completed “Community Teaching Experience Approval Form.”




Community Teaching Experience



Students must submit this form as part of the assignment submission.



Student Name:__________________

Course Section & Faculty Name:_____________________________

Date of Presentation:_____________

Provider Information

Provider Name :
Last First M.I.
Credentials: Title:
                      (i.e., MS, RN, etc.)
Phone Number:
E-mail Address:  


Student Presentation Information

Type of Presentation:
 PowerPoint Presentation  Pamphlet Presentation  Audio Presentation  Poster Presentation




 Provider Acknowledgement




I __________________________acknowledge that ____________________________

(Provider Name)                                                         (Student Name)


has requested approval to participate in a community teaching experience at the location listed on this form. The organization / agency does not endorse the university or the student however, the teaching plan developed by the student is considered appropriate and of benefit to the community of interest. NRS 428 Community Teaching Experience Approval Form






______________________________                                                _________________

Provider Signature                                                                                 Date Signed





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