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DACC Nursing Program Student Handbook 2012-2013APPENDIX – NDOÑA ANA COMMUNITY COLLEGE NURSING PROGRAMStudent Acknowledgement FormDIRECTIONS: Please click on the box to place an ―x‖ before each statement and sign at bottom of form to indicate you have readand understand the following statements. You can electronically sign and date the form by clicking on the appropriate boxes and clickthe email button to submit it or you may print it out, sign and date it and turn in a hard copy to the nursing office (Note: This form willbecome a part of your nursing program student record.)I understand nursing job opportunities could be limited within the geographical area surrounding Las Cruces, New Mexico at thecompletion of the Nursing Program and relocation to another area may be necessary for employment in nursing.I understand that licensing is required to practice as a Registered Nurse in the United States and that rules and regulations regardingissuance of licenses is governed by individual state boards of nursing.I understand that admission to or graduation from the DACC Nursing Program does not guarantee the graduate will be able to obtain alicense to practice nursing.I understand confidentiality regarding patient medical or personal information is mandatory during the nursing education process. Iagree to maintain patient confidentiality throughout the nursing education process. I will not purposely communicate patientinformation to any unauthorized person.I have read and understand all policies and information contained in the DACC nursing program handbook and the DACC studenthandbook and agree to abide by them.I acknowledge and understand that Doña Ana Community College does not provide insurance coverage for medical care that I mayneed because of my participation in DACC‘s Nursing Program.I further understand that there are certain risks and hazards that may arise in the course of this or related activities. I hereby assumeany and all of the inherent risks and hazards either directly or indirectly related to my participation in this program.I acknowledge that any claims for damages against Doña Ana Community College officers or employees and/or contract facilities,offers or employees for death, personal injury or property damage which may occur as a result of my participation in the abovementionedactivity would be governed by the New Mexico Tort Claims Act which imposes limitations on the recovery of damagesfrom state institutions and their public employees. For more information, please contact the NMSU‘s Central Purchasing office at(575) 646-2916, or visit http://www.nmsu.edu/~purchase/PDF%20Forms/Coverage.pdf.Note: It is the student‘s responsibility to seek clarification on any information he or she does not clearly understand.____________________________________________SignatureClick here to enter a date.DateUpdated: July 201165 | P a g e