COLLEGE OF SOUTHERN / UNIVERSITY NAME / OCCUPATION EXT. COLLEGE / / /
Organization
office of Admissions and Records / Human Services Department / Health Science and Human Services Department / / /
Position
Address STREET ADDRESS CITY Supervisor / IDAHO HEALTH RELATED WORK EXPERIENCE AND/OR VOLUNTEER EXPERIENCE Employer Phone No. Address STREET ADDRESS CITY STATE Supervisor / Employer Phone No. Address STREET ADDRESS CITY Supervisor / Chairman / WORK EXPERIENCE AND/OR VOLUNTEER EXPERIENCE Employer Phone No. Address STREET ADDRESS CITY STATE Supervisor / director of program / Practical Nursing Program Director / EDUCATION Official / /
DEPT. OF HEALTH SCIENCES AND HUMAN SERVICES 315 Falls Avenue • P. O. Box 1238 • Twin Falls, Idaho[removed]6700 • Fax: ([removed][removed]in Idaho and Nevada) TDD[removed]Web Site: http://