Nursing and MA StudentClinical Group Placement

Clinical Group Request Form for School Placement Coordinators

Only the school clinical placement coordinator should complete this request form.

Review and complete the following:

• Step 1: Ensure a school affiliation agreement is in place. If there is not an agreement in place, please contact WINursingClinicalAffiliations@aah.org. (New agreements may take up to 3 months to get into place).
• Step 2: You will need the following data to complete the request form:
  • Start and end date of the clinical
  • Instructor and student name (last, first, middle initial)
  • Level of student
  • Date of birth
  • Email address
  • Expected date of graduation
  • Total number of onsite clinical hours per student
• Step 3: Complete the clinical group request form. You will receive a confirmation email when we receive the request.
• Step 4: You will receive another email confirmation once leadership has approved or declined your placement request (at least 5 weeks prior to your clinical start date).

Note: This information will be required again for the Epic Access Request Form when completing post-approval tasks.

When requesting clinical placement for groups, it’s important to understand the deadlines for both traditional semester and trimester sequences.

Download AAH Clinical Placement Calendar for Group and Preceptorship Placements [PDF]

NOTE: Requests for Medical Assistant (MA) student placement should be submitted 6 - 8 weeks prior to the start of the clinical externship.

You will receive an email with the decision on your request at least 5 weeks prior to your clinical start date.

If your request is approved, the school clinical placement coordinator will need to complete and submit additional post-approval documentation.

The student and instructor confidentiality agreement and orientation checklist will be completed on the first day of the clinical by both the instructor and students.

Student and instructor confidentiality agreement and orientation checklist for all students and instructors