Va Form 10-0094b - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (Va), And A School Of Osteopathic Medicine Page 7

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DEPARTMENT OF VETERANS AFFAIRS SIGNATURE PAGE
Signature of VA Designated Education Official
4
Date of Signature
4
Typed Name of Individual Signing Above
4
Typed Title of Individual Signing Above
Signature of Director or Equivalent Responsible Official for the VA
Signature of VISN Director or Designee for Department of Veterans
Healthcare Facility
Affairs
4
4
Date of Signature
Date of Signature
4
4
Typed Name of Individual Signing Above
Typed Name of Individual Signing Above
4
4
Typed Title of Individual Signing Above
Typed Title of Individual Signing Above
Signature of Chief Academic Affiliations Officer, VHA Office of
Academic Affiliations, VA Central Office
4
Date of Signature
4
Typed Name of Individual Signing Above
VA FORM 10-0094b
PAGE 7 OF 7

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