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Get Nursing Student Clinical Group Placement Request Form

Ting precepted experiences. See separate request form on website. Name of School: Level of Student: Junior Senior Other Semester: 1st 2nd Requested Unit/Area (a separate request form must be completed for each unit/area/course requested) 1st Choice: 2nd Choice: Day(s) of Week: Time(s) on Unit/Area: Day and Time of Unit Prep: Start and End Date of Experience: Course Information/Description (Name and Number, please attach brief description): Number of Students: Course Coordinator (or person.

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