SCHOOL OF NURSING BETTY WHITE HEALTH CENTER

Graduate Nursing Program Adult-Gerontology Primary Care DNP Program Clinical Practicum Preceptor LETTER OF NOTIFICATION AND APPRECIATION

The purpose of this letter is to thank ___ for providing learning (Agency) opportunities for ___ who is enrolled in ___ at (Student)

Kentucky State University. The learning experience will begin on _____ and end _____ (Beginning Date).

(Ending Date)

___

Student Signature Date

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Student Name – Typed

___

KSU Representative Date

___

KSU Representative – Typed

___

Preceptor Date

___

Preceptor Name – Type

___

Appropriate Agency Official Date

___

Appropriate Agency Official – Typed

Address:

T11

Telephone:

Email:

Address:

Telephone:

Email:

Address:

Telephone:

Email:

Address:

Telephone:

Email: