Complete and submit this form AFTER you have successfully completed ALL of the learning required for your placement on the previous webpage. You must have JavaScript enabled to use this form. First name Last name Date of birth Email Elective/Placement start date By submitting this form you verify that you have completed: Privacy and Confidentiality Declaration: I acknowledge and agree to the Privacy and Confidentiality responsibilities and have reviewed and the Privacy and Confidentiality Agreement Statement. Online Required Learning Training Declaration: I acknowledge the completion of all required learning education modules. Patient Care Systems Training Declaration: I acknowledge, if applicable, that I have completed the assigned Cerner Journeys or FirstNet online training.
