Funeral Establishment Affiliation Agreement

MTSC 240-01 Practicum 1

Funeral Establishment Affiliation Agreement

Funeral Establishment Name:
Funeral Establishment Location:
Funeral Establishment Number:
Funeral Establishment Manager:
Funeral Establishment Manager Number:

agree to allow the named undersigned MTSC 240-01 Practicum 1 student of Kansas City Kansas Community College, to perform his/her MTSC 240-01 Practicum 1 requirements under the direct personal and physical supervision of the aforementioned Funeral Establishment, and an employed Qualified Licensed Preceptor, according to the MTSC 240-01 Practicum Guidelines.

Funeral Establishment Manager Signature:
MTSC 240-01 Practicum 1 Student Name:
MTSC 240-01 Practicum 1 Student E-mail:
MTSC 240-01 Practicum 1 Student Signature:

By submission of this Agreement, I certify that the above statements are true and correct to the best of my knowledge.

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