Participant Acknowledgement Form and Rotation Schedule
*This form must be completed by the learner*
The undersigned has applied to participate in a training program through Trinity Health - New England, Inc. (TH-NE) in Hartford, Connecticut. He or she understands that execution and submission of this Clinical Experience Participation Agreement is a pre-condition to commencing participation in the training program at TH-NE. Learners will not be eligible to engage in training at TH-NE until all forms have been received, reviewed, and approved.
Prior to commencing training activities at TH-NE, he or she shall complete the New Learner Orientation and Onboarding Process required by TH-NE. This includes the following:
- The Clinical Experience Participation Agreement – print from Step 2 Part 1, complete and return to your preceptor/coordinator
- The Participant Acknowledgement Form and Rotation Schedule – complete electronically (below)
- Learner Health Clearance Form – print from Step 3, have completed and faxed to Occupational Health
- The Confidentiality and Non-Disclosure Statement – print from the New Learner Orientation Information Packet (Step 4), sign and submit to TH-NE preceptor/coordinator
- The Code of Conduct and Corporate Compliance Plan Acknowledgement Statement – print from the New Learner Orientation Information Packet (Step 4), sign and submit to TH-NE preceptor/coordinator
- Language Services Training Presentation Sign-Off Sheet – read the Language Services Training Presentation PowerPoint (Step 5), then print the sign-off sheet and sign and submit it to TH-NE preceptor/coordinator
By checking this box, you hereby acknowledge that you have read and understand this Participant Acknowledgement Form and agree with the above conditions.
Please direct any questions about the form requirements to firstname.lastname@example.org