Educational Partner Information Update Forms

Information Update Forms
Lead Educator or Lead Faculty Change FormEducational Partner Contact and Information Update FormOther Information Update Form

Educational Partner Contact and Information Update Form
New Educational Partner Contact Name
New Educational Partner Contact Email
example@example.com
New Name of Educational Partner
New Educational Partner Postal Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
New Educational Partner Website
New Educational Partner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Lead Educator or Lead Faculty Change Form
Name of Educational Partner*
Educational Partner Postal Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Affiliate Website
Educational Partner hereby designates the undersigned individual below as Lead Educator or Lead Faculty pursuant to the terms and conditions of the Agreement.

In the event the Educational Partner desires to designate another individual as its Lead Educator or Lead Faculty, the Educational Partner shall promptly advise SCA by providing written notice on this form.

For questions, contact:

Email: admin@westberginstitute.org

Phone: (212) 644-1111 ext. 107
New Lead EducatorNew Lead Faculty
Lead Educator or Lead Faculty Acknowledgment

I, the undersigned, hereby acknowledge that I have read the Curriculum Agreement by and between the Educational Partner and SCA, and I elect to participate in rendering services pursuant to said Agreement as Lead Educator or Lead Faculty. As Lead Educator or Lead Faculty, I will serve as the Educational Partner's primary contact for the Foundations of Faith Community Nursing course and as the liaison between the Educational Partner and SCA. I agree to complete the required training provided by SCA and to fulfill all other duties and obligations of Lead Educator or Lead Faculty pursuant to the terms and conditions of the Agreement.
I, the undersigned, hereby acknowledge that I have read the Curriculum Agreement by and between the Educational Partner and SCA, and I elect to participate in rendering services pursuant to said Agreement as Lead Educator or Lead Faculty. As Lead Educator or Lead Faculty, I will serve as the Educational Partner's primary contact for the Foundations of Faith Community Nursing course and as the liaison between the Educational Partner and SCA. I agree to complete the required training provided by SCA and to fulfill all other duties and obligations of Lead Educator or Lead Faculty pursuant to the terms and conditions of the Agreement.
New Lead Educator or Lead Faculty Name*

First NameLast Name
New Lead Educator or Lead Faculty Credentials*
New Lead Educator or Lead Faculty Email*
example@example.com
Lead Educator or Lead Faculty Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
New Lead Educator or Lead Faculty Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Lead Educator or Lead Faculty Alternate Email
example@example.com
Signature*

Clear
Date*

MonthDayYear
Date

Other Information Update Form
Name of Educational Partner*
Please describe the information you would like to update:*

Click below to submit your form(s).

Thank you!
Should be Empty:

Information Update Forms

Educational Partner Contact and Information Update Form

Lead Educator or Lead Faculty Change Form

Lead Educator or Lead Faculty Acknowledgment

Other Information Update Form