1. Clinical Placement Request Instructions

2. Key Terms
Education Partner- The school designates one person responsible for submitting clinical placement requests (Program Director or Course Chair). Communication is enhanced by going through one person and decreases errors.
Clinical Placement Request Form (CP Request form)- arranged by tabs for each campus.
School Information section – complete all categories for the campuses you are requesting. Leaving the top portion blank signifies no requests for that campus.
Base-Unit section - departments where student groups are assigned.
Out- Rotation section - used for departments where individual or small numbers of students are assigned.

3. Key Terms
Instructor on Site (OS)- Faculty leader, on site, responsible for a group of students in Base-Unit and Out-Rotations.
Instructor Not on Site (NOS)- Faculty leader, not on site, but responsible for students in Out-Rotations.
Faculty/student group- Clinical instructor with a certain group of students.

4. Clinical Placement Request Process General Information
The Clinical Placement Request Form is located on Cone Health’s Clinical Placement web page:
School Education Partner completes the Clinical Placement Request Form and submits to prior to the deadline (see form).
Note a tab for each campus. Complete the school and contact information at the top of only the campuses where you are requesting placement.
Leaving the top portion blank indicates no requests for that campus.
1st choice clinical placements will be confirmed whenever possible, however, providing us with an alternative 2nd choice site is advisable.
Faculty will receive confirmation of approved clinical placement within 30 days of the clinical request deadline date.

5. Clinical Placement Request Process Specific Points
Complete information at the top of every campus you are requesting.
School information section not filled in indicates the campus is not being requested. Each component is important and must be included.
Total number of sites requested and total number of students (it is understood that this may be a close approximation).
Multiple Requests for the same department
When requesting a department and time frame (am/pm) for several Faculty/Student groups, assign a number to each student group and transfer that number to requested day/time and any other applicable cell.

6. Clinical Placement Request Process Specific Points
Fill in all pertinent information in Base-Unit section.
Faculty Name/ address and contact #; Type/Level of program/course number/#of students; Start date; End date; Alternative (2nd Choice); (OS) must identify the # of out-rotations; day(s) and hours requested.
Fill in all pertinent information in Out-Rotation section
Instructor on site (OS) – Indicate Base Unit location and # of students for each requested department (faculty information is found in the Base Unit area).

7. Clinical Placement Request Process Specific Points
Instructor Not on site (NOS) - * Faculty Name/ address and contact #; Type/Level of program/course number /# of students; Start date; End date; Alternative (2nd Choice); indicate ‘NOS’; # of students; and day(s)/hours requested.

8. How to Add / Cancel Requests
Additional Requests - Submit changes and additional requests via . These changes will be manually made to your original request. These should be kept to a minimum and due to time constraints, may not be able to be processed. Cancellations - Send a cancellation notification to The Cancellation should be sent as soon as possible, by the 2nd week of the semester at the latest. Write “….. semester cancellation of ……Department” in the subject line. Indicate Cancellation(s) in Red.

9. Changes / Additional Requests Email Format
Subject line: School /Semester/ Clinical Placement change / Additional Request
In the body of the list:
Department adding or changing
Days / times
Faculty / contact information
A confirmation will be sent back to you.

10. Confirmation Process
The confirmed request will be returned within 30 days. Carefully review the confirmed request; modifications may have been made.
Approved requests remain unchanged when confirmed. Subtle changes may have been made (ex. timeframes slightly adjusted).
Unable to Approve requests will have a strike through.
2nd choice alternative may have been assigned
If 1st & 2nd choice request is not available, the school Education Partner will be contacted and encouraged to access the web site to select alternative options.

11. Questions Contact Clinical Education Coordinator Staff
Questions Contact Clinical Education Coordinator Connie Lewter