NUR 4106 Student Clinical Agreement

I agree to complete the required 90 (ninety) hours at the designated site under the supervision of the identified preceptor.

Preceptor Preceptor First Last
Clinical Site
Submission of this f orm indicates agreement to all of the following:

Submission of this f orm indicates agreement to all of the following: I will notify the preceptor prior to the beginning of the clinical experience to reschedule for any absences that occur. I will submit documentation of clincal hours. I will assume responsibility for accomplishing course outcomes and individual learning objectives. I will follow specific agency requirements such as dress code, agency polocies, health requirements, and CPR certification. I will submit a log of the clinical experiences as outlined by the syllabus. I will assume all cots involved int he experience such as transportation and food. I will assist the preceptor to complete the preceptor agreement and information form online I will inform the clinical preceptor and clinical coordinator of problems that arise during the experience. I will seek the supervision and feedback from the preceptor on an ongoing basis. I will participate in self-evaluation by completing the Clinical Evaluation Grading Tool at midterm and the conclusion of the course to determine if outcomes and objectives have been met. I will retain and provide a copy of this document to your preceptor.
Signature Signature First Last
Date Date / MM / DD YYYY