after Initial Approval Issued form LSBN Clinical Student Information Name: __________________________________________________________________________ Address:_________________________________________________________________________ Phone: _____________________________ DOB: ________________________________ Email Address: __________________________________ Student#__________________________ Name and Type of Nursing Program: _____________________________________________________ Reason for Dis.
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How to fill out the LA STU 04 online
The LA STU 04 form is crucial for clinical nursing students who need to disclose specific incidents after their initial approval. This guide provides clear instructions on how to accurately complete the form online, ensuring you provide all necessary information. Follow the steps carefully to avoid any complications with your application.
Follow the steps to fill out the LA STU 04 form online.
- Press the ‘Get Form’ button to obtain the LA STU 04 form and open it in your preferred online editor.
- Fill in your personal information at the top of the form, including your name, address, phone number, date of birth, email address, and student number.
- Specify the name and type of your nursing program in the designated field.
- In the 'Reason for Disclosure' section, check the box next to all applicable reasons for your disclosure. Ensure you read each option carefully.
- For each reason checked, prepare to provide a detailed statement explaining the associated incident, including necessary dates and other relevant information.
- Gather the required certified true copies of documentation that support your disclosure. This may include arrest records, court documentation, military discharge documents, medical records, or substance abuse treatment records.
- Once all required fields are complete and supporting documents are attached, review your information for accuracy.
- Finally, sign and date the form in the designated areas for both the student and dean/director, and ensure you save your changes.
- Choose to download, print, or share the completed form as needed.
Start filling out the LA STU 04 form online today to ensure your disclosure is completed accurately.
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