APP Online Orientation Attestation

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East Jefferson General Hospital APP Student Online Orientation Attestation

Please Note: This form is only for APP students enrolled in schools with an established affiliation agreement with LCMC

Please review the EJGH Orientation Experience Packet prior to submitting this form

Student's First and Last Name*

First Name

Last Name

Student's Phone Number*

Student's Email*

Select Your School Affiliation (Must have affiliation agreement with LCMC)*

LSUHealth New Orleans School of Nursing Franciscan Missionaries of Our Lady University

Other:

Program of Study*

CRNA NNP FNP ACNP

Other:

Anticipated Graduation Date*

Location of Clinical Rotation *

Hospital Only Clinic and Hospital Clinic Only

Dates of Clinical Rotation - Begin Date*

Please begin date of your EJGH Clinical Rotation

Dates of Clinical Rotation - End Date*

Please end date of your EJGH Clinical Rotation

By my signature below I attest I have read the EJGH Orientation Packet and will comply with the information presented to me.*

Use your mouse or finger to draw your signature above

Anesthesia Contacts & First Day Instructions

Anesthesia Contacts and Phone Number: 504-503-5560

Day 1 Instructions:

Park in the Esplanade Garage above the second floor up
Arrive at the 3rd floor OR desk @ 0630 (ask for the Anesthesia Work Room)
Hospital laundered scrubs are required and must be donned and doffed each shift
Wear your School Identification Badge at all times while on premises

Day 1 Instructions: