Pathway Director Approval Form

Special Elective Request

 

I have discussed this proposed special elective opportunity with the student. The elective meets my approval as Pathway Director for the student.

 

 

STUDENTíS NAME (Print)

 

STUDENTíS SIGNATURE

 

TITLE OF PROPOSED ELECTIVE

 

HOSPITAL OR SITE OF PROPOSED ELECTIVE

 

START DATE OF ELECTIVE

 

END DATE OF ELECTIVE

 

 

 

PATHWAY DIRECTOR (Print name)

 

 

 

SIGNATURE