Relevant. Resolute. Ready.
Date:
Student name:
Program name:
Last date of attendance:
| Number of hours of classroom completed (classroom & lab): | S1= | |||
| Hours required for successful completion (classroom & lab): | T1= | |||
| Number of hours of clinicals completed: | S2= | |||
| Hours required for successful completion (clinical): | T2= | |||
| Percent completed: |
|
Dismissal. Reason(s):
Withdrawal. Reason(s):
Comments:
| Relevant. Resolute. Ready. | |