PN Acknowledgement of Essential Functions Form

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Acknowledgment of Essential Functions- Practical Nursing*

Without reasonable accommodations

With reasonable accommodations (documentation must be attached)

Please check one

By signing below, I acknowledge that I have read and understand the Essential Functions for the Practical Nursing Student. I believe to the best of my knowledge that I have the ability to learn and perform the Essentials Functions*

Date (mmddyyy)*

Which program are you applying for?*