Associate Degree Nursing and Practical Nursing Technical Diploma Program

Student Handbook Signature

Please complete this form ONLY after reading the Associate Degree Nursing and Practical Nursing Technical Diploma Student Handbook.

First Name

Last Name

Student ID Number

Phone Number

Nursing Handbook: I have read and understand the Nursing Program Student Handbook at this time and agree to abide by its policies and guidelines. I understand that in the future, I am responsible to access and know the information included in the most current version of the handbook available on the LTC website. I will contact the Associate Dean of nursing or program advisor if I have any questions about the content of the handbook.

Academic Integrity: In academic and professional matters, I will not lie, cheat, steal, nor tolerate those who do. I will not disclose the content of examination items before, during or after the examination. I will not give nor receive, nor will I tolerate others’ use of unauthorized help on exams and assignments. I understand that violation of the Academic Integrity Code will result in disciplinary action up to and including dismissal from the program.

Confidentiality Statement: I understand and agree that as a nursing student at Lakeshore Technical College, I must hold all client information in the strictest confidence. Furthermore, I understand that intentional or careless violation of client confidentiality is a breach of nursing ethics, a violation of state and federal law, and will result in disciplinary action up to and including dismissal from the program.

Social Media: I have viewed the “Social Media Guidelines for Nurses”. I understand that I must not use social media while participating in clinical courses or to share patient information in any form. Violation of this is a breach of client confidentiality and program policy will result in disciplinary action up to and including dismissal from the program.

Electronic Signature

By signing below, I agree all information and answers provided in this form are true and correct.

Signature: (Full name required)

Date: (MM/DD/YYYY)