Statement of Accuracy

Statement of Accuracy

Rev. Dec 2007

My signature on this statement indicates that :

I certify that the information given on my online application is complete and correct to the best of my knowledge. I give UDM permission to verify it.

I have attended no institutions of higher education other than those listed on my online application.

I have not been dismissed from, or resigned from, any academic program in the past, including a program of nurse anesthesia education. I agree to provide details on a separate sheet of any prior resignation or dismissal.

I do not currently suffer from any mental disease or disorder which would have an impact on my performance as a Registered Nurse or nurse anesthetist. I agree to provide details on a separate sheet if I do have such a disorder, providing details of current treatment.

I have had no actions taken by any state board of nursing against my Registered Nurse license. If so, I agree to provide details on a separate sheet.

My privilege to practice as a Registered Nurse has never been limited in any way by an employer. If so, I agree to provide details on a separate sheet.

I understand that UDM can accept only original transcripts and original GRE score reports, sent directly from those institutions. I understand that I am responsible for arranging for the forwarding of official transcripts from the colleges/universities I have attended, and that such transcripts become the property of the University of Detroit Mercy and will not be returned.

I waive my right to the inspection of completed recommendation forms, or any recommendation letters sent on my behalf.

I also consent to the release of data concerning my scholastic progress for use in research and planning for higher education.

I understand that enrollment in the nurse anesthesia program is contingent on successfully passing a health and drug screening as well as a criminal background check.

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Signature, Date