COLLEGE OF NURSING
STUDENT ROTATIONAL CLEARANCE
                                    1st Semester, SY 2018-2019
Name:Bgasiyao,Ashlene Kate                                 Year & Section/Group: Level IV – S2 – Group B
          HOSPITAL                 DATE           TIME/SHIFT     CLINICAL INSTRUCTOR      DATE SIGNED
    Ward/Community/Area          MM/DD/YR
          Juliet Avena       /    Ken Fias-ilon                                    Judith Layao
    CLINICAL COORDINATOR / COMMUNITY COORDINATOR                                    AREA HEAD
              (Printed Name and Signature)                              (Printed Name and Signature)
                                     Judith Odanee Magwilang
                                           COLLEGE DEAN
                                   (Printed Name and Signature)
UC-VPAA-CON-FORM-09_RLE
APRIL 2015       Rev 00