Name *

First Name

Last Name

Date of Submission *

MM

DD

YYYY

I have submitted my module by email *

I have emailed my module to nmistudygroup@nationalmidwiferyinstitute.com. I have made sure I followed submission and formatting instructions carefully, as outlined in my module syllabus. I have submitted a .pdf document, as requested.

I have read the fine print. I have emailed my module.

The work I have submitted is my original work *

I have not plagiarized my work, rather, my work is in my own words and reflects my own unique ideas. When sourcing ideas form others, I have quoted, cited, and/or attributed their ideas properly. If there is any question about the originality of my work, a Study Group Coursework Coordinator will contact me.

I have read the fine print. I certify that I have submitted original work.

I have submitted a module feedback form *

I understand I must submit at least ten module feedback forms throughout my time completing Study Group Coursework. These module feedback forms solicit student feedback in order to improve modules and keep them relevant and up-to-date for optimum student education.

Yes, I submitted a module feedback form for the module selected above

No, I have not chosen to submit a module feedback form for the module selected above.