Academic Report Form Academic Report Tracking Form (1) This form is used to track the sign-up and progress of students taking HODS training courses. Simply fill out the fields below, select the Module or Course from the pull-down selections, user check-boxes as appropriate and submit to send to Administration. Name First Last ModuleSelect Module – Select CourseModule 0 – Clinical Utility of Dx TestingStage 1 / M1 - Online – Basic EMG/NCS - OnlineStage 1 / M1 - Live– Basic EMG/NCS - LiveEMG Mentorship 1 – EMG Mentorship 1EMG Mentorship 2 – EMG Mentorship 2Stage 2 / M3 - Online – Intermediate EMG/NCS - OnlineStage 2 / M3 - Live – Intermediate EMG/NCS - LiveStage 3 / M4 - Online - EMG Pathology & Other TopicsStage 4 / M5 - Online - Advanced EMG/NCS - OnlineStage 4 / M5 - Live - Advanced EMG/NCS - LiveMentored Studies - 25 NormalsMentored Studies - 25 StudiesExam - Written ExamExam - Practical ExamF-EMG Completion - F-EMG CompletionDate Date Format: MM slash DD slash YYYY Pass/Fail/Done Pass Fail Done
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