Nursing Graduate Student Clinical Placement Form

Thank you for your interest in Premier Health. We are excited to help you on your academic journey.

Please complete the following form: all fields are required.

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

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

Full Name

Email Address

School Name

Program Type

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?

Name and credentials of preceptor (optional)

Type of clinical experience needed

We DO NOT accept placement requests for Women's Health, Mental Health & Pediatric.

Practitioner Types (optional)

Choose all types of disciplines that would be acceptable.

Exact Dates of Clinical experience

Begin date

End date

Number of hours needed