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Penn Nursing Alumni Liaison Program 2007

Thank you for your interest in participating in this Fall’s Alumni Liaison Program!

The Alumni Liaison Program increases student awareness of the roles nurses play and reinforces their identification with the nursing profession by providing them with an opportunity to "shadow" a Penn Nurse alumnus at work for a day.

If you work in the Philadelphia area, you can host a first year student for a workplace visit. This is an opportunity for you to share your experience and expertise as you give new students their first meaningful look at nursing.

Please take a moment to fill out the form below and click submit. You will be contacted in September with your student assignment. We look forward to working with you in the fall!

CONTACT INFORMATION
Current Name:
Name at graduation:
Degree and graduation year:	HUP BSN MSN PhD
Home Address1:
Home Address2:
City:
State:
Zip:
Phone:
Email address:

PROFESSIONAL INFORMATION
Job Title:
Dept/Specialty:
Employer:
Address 1:
Address 2:
City:
State:
Zip:
Phone:

ASSIGNMENT PREFERENCES
I am willing to host :	Number of Students: 1 2 3 4 +
CONTACT ME
I prefer to be contacted by:	Home Phone Business Phone Email