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Nurse Practitioner/Post-Graduate

Advanced Clinical Practicum

Students in need of Nurse Practitioner or Post-Graduate practicums are to submit the NP/Post-Graduate packet to request a preceptorship experience at Grady or in the Grady Clinics. Once the request has been approved, the student will be cleared for a preceptor assignment with an approved preceptor by the Student/Faculty Placement Coordinator. The Nursing Education, Practice and Research department does not secure a nurse practitioner preceptor, but will provide a list of available preceptors to the Clinical Coordinator or Nursing Program representative. The student will then be able to utilize this list and negotiate preceptor arrangements via email or telephone.

Each student is responsible for securing a preceptor and having that preceptor validate willingness to precept by signing and dating the appropriate form in the packet.
Requests will be processed according to received dates. Request for preceptors are cleared according to available staff to precept and approval by the unit directors.

Placement Request

Student Contact Information:
Student Name:*
First Middle Last
Mailing Address:*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone:*
Email:*
Practicum Request:
Program Type:*
- NP
- MSN
License #:*
Affiliated School:*
Course Name & #:*
Instructor's Name:*
First Last
Instructor's Email:*
Preceptor’s Name:*
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 Practitioner/Post-Graduate

Advanced Clinical Practicum

Placement Request

Student Contact Information:

Practicum Request: