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Cebu Doctors’ University

College of Nursing
Mandaue City

REQUEST FORM FOR ON-CALL/VOLUNTEER DUTY

April 09, 2010

Dr. Ofelia F. Sisno


Dean, College of Nursing
Cebu Doctors’ University

Dear Dr. Sisno:

I, Jan Mikhail Alexei Ong, a level IV student would like to ask from your good office to allow
me to go on on-call/volunteer duty on ___________________, at ______________________.
This is for the completion of my OR requirements. My father, Michael Ong, will bring me to the
_________________ and will fetch me from the said area of assignment. Should you wish to
contact me, I can be reached on the following numbers: +639233146864.

I understand that the school will not be held responsible for any untoward event as a
consequence of this on-call/volunteer duty.

Hoping for a positive response.

Thank you and God bless.

Respectfully yours,

___________________
Mr. Jan Mikhail Alexei Ong
CDUCN - SN
BSN 4 – H

Noted By:

___________________
Ms. Joselle Dalman
Record Adviser

___________________
Mrs. Dolores M. Saldivia
Clinical Coordinator

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