Choice Program - Confirmation FormCongratulations! Your application for tuition assistance from the Kaiser Permanente (KP) Nurse Scholars Academy has been reviewed and approved for the Choice program. Follow the instructions below to confirm your participation in the Choice program. Provide your name, NUID, and email address. Confirm and check off each of the program requirements. Sign and submit the form. Applicant InformationNUID*Name* First Last KP Email Address* Program Requirements Confirmation1. KP Nurse Scholars are expected to apply learnings to KP to improve professional practice, patient outcomes, and the delivery of high quality and affordable care for our members.* I Agree 2. We are honored to invest in your future and do so with the expectation that you will commit to continued service at KP for a minimum of two years following your graduation.* I Agree 3. The Choice program is funded by NCAL KFH/HP. If you leave the organization, or transfer to another KP entity or region, you may be ineligible for future tuition assistance.* I Agree 4. Tuition assistance disbursed by the Choice program may only be used to pay for the specific degree program identified on your application.* I Agree 5. Periodically you will be expected to participate in Nurse Scholars evaluation surveys.* I Agree 6. Clinical hours and practicum experiences are the sole responsibility of each student and school contracts for clinical placements should be verified.* I Agree 7. Receipt of Choice program tuition assistance should not be considered as an endorsement or recommendation of any academic institution or course of study.* I Agree 8. If you are interested in reapplying for the Choice program next year please refer to the KP Nurse Scholars Academy website for eligibility criteria (subject to funding availability).* I Agree 9. I confirm my acceptance of the 2019 Choice program tuition assistance.*I AgreeI DeclineSignatureYour Signature*Use your finger or stylus (phone or tablet) or your mouse (PC or Mac) to sign in the space below.