written notice of such intent. I agree to provide service as a student under the conditions indicated in my affiliation agreement. Date: Signature of Appointee: TO BE COMPLETED BY REQUESTING SERVICE TRAINING DIRECTOR Duty VA Station Supervisor 673 Sonji Blanks, MSN/Ed, RN Clinical Nurse Educator Position Title: Nurse Trainee Area WOC to Type of Work to be Performed (please attach clinical objectives): Attend No Yes NEO: Computer Yes No Access Needed:
written notice of such intent. I agree to provide service as a student under the conditions indicated in my affiliation agreement. Signature of Appointee: Date: TO BE COMPLETED BY REQUESTING SERVICE TRAINING DIRECTOR Duty Station 673 VA Supervisor Sonji Blanks, MSN/Ed, RN Clinical Nurse Educator Position Title: Nurse Trainee WOC Area to Type of Work to be Performed (please attach clinical objectives): Attend NEO: No Yes Computer Access Needed: Yes No