Nursing Student Precepted Placement Requests :: Nationwide Children's Hospital

Nursing Student Precepted Placement Requests

Application for Undergraduate and Graduate Precepted Nursing Student Placement at Nationwide Children’s Hospital 2010-2011

  • A separate “Application for Precepted Student Placement” form needs to be completed for each course.
  • While Nationwide Children’s Hospital will place as many students as possible each term, there is no guarantee of receiving all placements requested.  Requests are made equitably among all schools requesting placements each term.
  • All placements should be requested through the Department of Professional Development.
  • Please confirm the number of preceptors needed a minimum of 4 weeks prior to the start of the term.  Placements will not be finalized until this confirmation is received.
Nursing Student Precepted Placement Request
Please complete all fields
Person completing this form (include title): *
Name of College/School of Nursing: *
CLINICAL ROTATION DESCRIPTION
Course Name, number and short description: *
Type of program: *
Preferred Clinical Experiences: *
Does the placement require direct patient care? *
Yes
No
Number of clinical hours needed per student? *
Please list any additional preceptor/placement requests (i.e., shift requirements; BSN prepared preceptor; inpatient or main campus only):
TERM ONE
Select one: *
Start Date: *
End Date: *
Anticipated number of placements needed: *
TERM TWO
Select one:
Start Date:
End Date:
Anticipated number of placements needed:
TERM THREE
Select one:
Start Date:
End Date:
Anticipated number of placements needed:
TERM FOUR
Select one:
Start Date:
End Date:
Anticipated number of placements needed:
CLINICAL PLACEMENT COORDINATOR
All communications regarding placements will be sent to this person.
Name: *
Email: *
Phone number: *
COURSE COORDINATOR
Name: *
Email: *
Phone number: *
QUESTIONS?
Please add any addition questions, concerns or comments you have for our Schools of Nursing Affiliations Coordinator.
Questions or comments:
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000