Student attestation form 2026

1. Click ‘Get Form’ to open the student attestation form in the editor.
2. Begin by entering your personal information. Fill in your name, phone number, email, and school in the designated fields.
3. Indicate whether this is your first time at a ProMedica facility by checking the appropriate boxes for Core and Clinical modules. If applicable, submit a separate Error Prevention Certificate.
4. For subsequent visits within the same academic year, check 'yes' as needed. If it’s not within the same year, mark the relevant Core and Clinical modules.
5. Review the objectives listed to ensure you understand them. This section confirms that these topics have been covered in your curriculum.
6. Sign and print your name at the bottom of the form, along with the date. Ensure you understand the confidentiality statement before signing.
7. Once completed, print, sign, and return this form to your instructor or clinical preceptor prior to starting your learning experience at ProMedica.

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