Va Letterhead Template PDF Details

In our examination of the complexities surrounding the integration of students into practical work environments within the healthcare sector, particularly those associated with the Department of Veterans Affairs, the VA Letterhead form surfaces as a pivotal document. This form, originating from the Robert J. Dole VA Medical Center in Wichita, KS, serves as a formal welcome and agreement between the student and the Department of Veterans Affairs. It outlines the terms of the student's affiliation with the medical center, specifying the nature of their assignment under the authority of 38 U.S.C. 7405(a) (1) (D), which allows for certain types of work without monetary compensation. These positions, while not offering salary or standard employment benefits such as leave or retirement, do provide other types of support designated in the document. Importantly, the form emphasizes the eligibility of benefits that do not include monetary compensation, such as quarters, subsistence, uniforms, and laundering of uniforms, setting clear expectations for the student's role. Furthermore, it addresses administrative necessities such as providing personal information and agreeing to the terms of service, including the opportunity for either party to terminate the agreement with written notice. The inclusion of veteran status, with a specific note on Vietnam Veterans, underlines the VA's ongoing commitment to recognizing and categorizing the veteran status of its affiliates for statistical and program planning purposes. This document encapsulates the formal beginning of a student's practical experience within the VA system, bridging educational aspirations with the realities of healthcare service delivery in a veteran-focused environment.

QuestionAnswer
Form NameVa Letterhead Template
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesva doctors note template, letterhead templates printable pdf, va letter head, va letter template

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DEPARTMENT OF VETERANS AFFAIRS

Robert J. Dole

VA Medical Center

5500 E. Kellogg

Wichita, KS 67218

In Reply Refer To: 589A7/EDU

Robert J. Dole Medical Center

5500 E. Kellogg

Wichita, KS 67218

Dear _______________________:

(Student Name)

Welcome to the Department of Veterans Affairs, Robert J. Dole Medical Center, Wichita, KS.

You will be assigned to our facility as a Student fromthrough, under authority of 38 U.S.C. 7405(a) (1) (D). During your period of affiliation with our facility, you are authorized to perform services as directed by the Service Director(s), Associate Director of Patient Care.

In accepting this assignment, you will receive no monetary compensation and you will not be entitled to those benefits normally given to regularly paid employees of the Department of Veterans Health Administration, such as leave, retirement, etc. You will, however, be eligible to receive benefits indicated below. Cash cannot be paid in lieu of any of these benefits.

Quarters

Subsistence

Uniforms

Launder of uniforms

None

If you agree to these conditions, please fill in the information requested on the reverse side of this document and sign the statement. This agreement may be terminated at any time by either party by written notice of such intent.

Sincerely,

NANCY J. GERSTNER

Human Resources Director

Social Security No:

Date of Birth:

VHA Contact Phone Ext: 57905 VHA Supv/Mentor: Travis Nickelson, RN, BSN

I agree to serve in the above capacity under the conditions indicated. If you agree, sign below.

Veteran Status (Please circle one)

1 - Vietnam Veteran*

2 - Other Veteran

3 - Non-Veteran

*For this purpose, a Vietnam Veteran is one with service between August 5, 1964 and May 7, 1975.

Signature: ______________________________

Date:

Please indicate your veteran status in box at left.

Pursuant to the Privacy Act of 1974, the information about your veteran status is requested under Title 38 United States Code and will be used to help identify veterans status of all VA trainees for statistical and program planning purposes. It will not be used for any other purpose. Disclosure of the information sought is voluntary. Failure to furnish this information will have no adverse effect on any benefits to which you may be entitled.

RCS 10-0161 Report

 

 

 

 

 

 

 

 

 

 

School Affiliation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Program (Place X in box):

 

 

Doctoral

 

Masters

 

BA/BS

 

Associate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certificate

 

 

 

Diploma

 

 

Other (Specify) __________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Program Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WOC Position Title:

Approximate total hours scheduled to be at VAMC:

How to Edit Va Letterhead Template Online for Free

Completing va letter head is simple. Our experts created our editor to make it simple to use and assist you to fill in any PDF online. Below are a few steps that you need to adhere to:

Step 1: You should press the orange "Get Form Now" button at the top of the website page.

Step 2: Now you will be on your form edit page. You'll be able to add, update, highlight, check, cross, add or erase areas or text.

Feel free to provide the next information to prepare the va letter head PDF:

pdf letterhead template blanks to fill in

In the Social Security No Date of Birth, VHA Contact Phone Ext VHA, I agree to serve in the above, Signature, Date, Veteran Status Please circle one, Please indicate your veteran, and Vietnam Veteran Other Veteran box, put in writing your information.

part 2 to filling out pdf letterhead template

Type in the necessary data when you find yourself on the RCS Report, School Affiliation, Type of Program Place X in box, Certificate Diploma Other Specify, Program Title, WOC Position Title, and Approximate total hours scheduled section.

part 3 to completing pdf letterhead template

Step 3: After you hit the Done button, your prepared form can be easily exported to any kind of your gadgets or to electronic mail specified by you.

Step 4: Generate a copy of any file. It can save you some time and enable you to stay clear of difficulties as time goes on. Keep in mind, your information is not used or analyzed by us.

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