By submitting this form, I acknowledge that it is my responsibility and that I attest that I am in full compliance with UMDNJ Student Health Requirements as outlined in the current version of the SN Student handbook. Furthermore, I understand that it is my responsibility to ensure that I am in compliance with all requirements of the host facility, up to and including (if required) completion of an updated criminal background check and/or drug screening. Lastly, I acknowledge and agree to comply with the practice that all University and host facility requirements are completely and satisfactorily fulfilled and that the clinical preceptor letter has been signed and returned to UMDNJ prior to the start of my clinical rotation.