[PT2021] Consent and Release to Disclose Personal Information.docx

[Shearin, Heidi]

Hello,

I hope you are enjoying your time off before starting DPT 802.  We need to update our records to cover any information necessary for clinical placement processing for DPT 802 and 804.  This includes immunization records, results from a criminal background check, etc.  Please update the annual disclosure form for this information. Clinics require this information and failure to complete can impact progression in the program.

Action Item: Please read, review, and sign the attached document and upload to Exxat BY THIS FRIDAY, 3/26/21 at 5pm.

Please let me know if you have any questions.
Thank you!

Dr. Shearin


Heidi Shearin PT, DPT I Campbell University
Director of Clinical Education & Assistant Professor of Health Sciences
Doctor of Physical Therapy Program
College of Pharmacy & Health Sciences
[cid:image001.jpg at 01D71FEB.52EB0AB0]cell 919-770-6386 preferred due to remote work
Office: 910.893.1725 l  Fax 910.814.5567 l Email: shearin at campbell.edu<mailto:shearin at campbell.edu>
Tracey F. Smith Hall, Room 118B
4150 US 421 South, Lillington, NC 27546
Mailing Address:
P.O. Box 1090
Buies Creek, NC 27506
[cid:image002.png at 01D71FEB.52EB0AB0]
Like us: www.facebook.com/campbelldpt<http://www.facebook.com/campbelldpt>

The DPT Program at Campbell University is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria, Virginia 22314; telephone: 703-706-3245; email: accreditation at apta.org<mailto:accreditation at apta.org>; website: http://www.capteonline.org<http://www.capteonline.org/>.  If needing to contact the program/institution directly, please call 910-893-1720.



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