Student Clinical Placement Application Form

Please select your area of interest.

(e.g. Jan - Mar)

Please identify and document your learning objectives for your placement. Note, objectives should be measurable and generally focused on learning opportunities within your selected focus area.

Please provide a brief outline or plan for achieving your learning objectives

Please indicate how you will evaluate if your objectives have been met

Describe how you believe a placement in this focus area will benefit your nursing practice

Describe any prior work experience and/or volunteer work relevant to a placement in this focus area