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This document is for use by a BSWH-affiliated school to attest their compliance with the affiliation agreement allowing students and/or faculty to participate in clinical rotations at BSWH.
To comply with the affiliation agreement signed between _________ (school - to be entered in blank below) in _________ (city - to be entered in blank below) _________ (state- to be entered in blank below) and Baylor Scott & White Health (BSWH), this letter is to attest that all faculty and students listed in the included table have met the requirements check marked below for participation in the referenced education program.
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Select all that apply.
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Select all that apply.
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Select all that apply.
Student(s) and Faculty listed below have met the check marked requirements. Please complete an additional attestation if more than 50 students.
Authorized School Submission
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By entering your name in the blank you are attesting the above information is correct and true and you are authorized to certify the information on behalf of the school.
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