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Nurse Clinical Rotation

Clinical Rotation

An affiliation agreement between Grady and the School of nursing is required to be in place prior to any clinical experiences.

All nursing programs must submit a request for clinical rotation form which includes the name of the student(s), faculty, and assurance that a current unencumbered Georgia nursing license is active at the time of application and during all clinical experiences for faculty seeking clinical placement. Individuals serving as clinical faculty are required to complete an orientation to patient care services through attendance at a live session and completion of required online orientation modules annually.

Placement Request

Clinical Coordinator Contact Information:
Clinical Coordinator Name:*
First Middle Last
Mailing Address:*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone:*
Clinical Coordinator Email:*
Clinical Rotation Request:
Affiliated School:*
Semester:*
Student Level:*
Number of Students:*
Course name & #:*
Instructor's Name:*
First Last
Instructor's Email:*
Area of interest:*
Number of Hours:*
Shift:*
- Day Shift (7A - 7P)
- Night Shift (7P - 7A)
Start Date:*
MM slash DD slash YYYY
End Date:*
MM slash DD slash YYYY
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Nurse Clinical Rotation

Clinical Rotation

Placement Request

Clinical Coordinator Contact Information:

Clinical Rotation Request: