Weekly Conference Form

First Name:*

Last Name:*
Email:*
Today's Date: 11/28/2023 9:56:30 AM
Clinical Educator:*
Clinical Educator Email:*
University Supervisor:*
University Supervisor Email:*
Week Of:* (Must select a date on Calendar.)
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Times Tardy:
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click the 'Submit' button ONCE in a session. If you unsure your form was submitted OR you got a 'critical error' notice in a pink box after form submission, please contact Kellie Hatch to verify if the form was submitted sucessfully.