Remote Learning Declaration Form
Please complete the Remote Learning Declaration Form to confirm your participation and arrangements for remote learning.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Institution Name
*
Class/Course Name
*
Student ID (if applicable)
Remote Learning Period
*
Mode of Remote Learning
*
Please Select
Live Online Classes
Recorded Sessions
Self-paced Modules
Other
Do you have access to a suitable device for remote learning?
*
Yes
No
Do you have reliable internet access for remote learning?
*
Yes
No
Attendance Availability Confirmation
*
I confirm I am available to attend all required remote learning sessions.
I may have attendance challenges (please specify below).
Remote Learning Declaration: I declare that the information provided in this Remote Learning Declaration Form is true and accurate to the best of my knowledge.
*
I agree
Submit
Should be Empty: