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Account Information

Application Questions

Thank you for participating in the Collegiate Health Service Corps this semester, please complete the following post-program survey.

Authorization & Consent

I certify that the information provided is accurate, I also understand that participation in the Collegiate Health Service Corps requires attendance at all activities (unless time off has been excused). The Collegiate Health Service Corps and its agents are given permission to reproduce for publications and Internet use any photos taken at program functions. If I choose to withdraw my permission, I must provide written notification.

I Agree

Confidentiality Agreement

As a Collegiate Health Service Corps Participant I agree to follow all rules, policies, and procedures of both my service learning site and the CHSC to the best of my ability. I also agree to respect the confidential nature of all records and any personal contact I may have with the community and other CHSC participants. I understand that I am expected to be professional and maintain confidentiality at all times, whether dealing with client records, projects, or conversations, and abide by the obligations of contractual confidentiality agreements. This includes, but is not limited to conversations, computerized information, and participant/community records and charts. I will report any suspected breaches of confidentiality to my AHEC Collegiate Health Service Corps Coordinator.

I Agree


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