Nursing Student Precepted Placement Requests Person completing this form (include title): Name of College/School of Nursing: Ashland University Capital University Chamberlain College of Nursing Mount Carmel College of Nursing Mount Vernon Nazarene University Muskingum University Ohio Northern University Ohio University Athens Ohio University Chillicothe Ohio University Zanesville Otterbein University The Ohio State University Xavier University Clinical Rotation Description Course Name, number and short description: Type of program: Community Leadership Senior/Transitions Preferred Clinical Experiences: Does the placement require direct patient care? No Yes Number of clinical hours needed per student? Dates Select one: Fall (Aug-Dec) Spring (Jan-May) Summer (Jun/Jul) Start Date: End Date: Anticipated number of placements needed: Clinical Placement Coordinator All communications regarding placements will be sent to this person. Name: Email Address Phone Number: Questions?Please add any additional questions, concerns or comments you have for our Schools of Nursing Coordinator. Questions or comments:
