Advanced Practice Provider Student Clinical Placement Interest Form

Thank you for your interest in Premier Health. We are excited to help you on your journey to become an Advanced Practice Provider. We look forward to getting to know you better.

Please complete the following form: all fields are required.

If you need placement for more than one clinical rotation in a semester, please submit the form for each rotation.

Premier employees are given priority placement. Student placements are not guaranteed.

Are you currently a Premier Health employee?

Premier employees are given priority placement.

Have you found a preceptor who has agreed to the requirements of your clinical experience?

i.e. Women’s Health, Pediatrics, Mental health, Acute care, etc.

Practitioner Types

Choose all types of disciplines that would be acceptable.

Exact Dates of Clinical experience