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Clinical Rotation/Observation Forms Request

You are on this page because you have been directed to this link to request the proper paperwork for Clinical Rotation/Observation. Please complete the form below on the topic that matches your need.

MEDICAL, APRN, AND PA STUDENTS PLEASE NOTE:

For certain clinical areas, the student must be first be approved by the Medical Executive Committee (MEC) prior to starting the clinical experience. Requests submitted after the second Thursday of each month will be held until the following month’s MEC meeting. Please be aware that completing an application does not guarantee placement, as opportunities are limited. Once the application has been received please allow at least 8 weeks for processing.

* Required Field

First Name *: Last Name *: Email Address *: Phone Number *: Applicant Type *: Select High School Students & Non-College Students (Must be 16 or older to apply for observation experiences)College StudentsNursing Students (Non-APRN Nursing Students)Medical Student/Physician Assistance/Nurse Practitioner Students Application Type *: Select Observation (if the experience is only observation)Clinical Application (must have Education Agreement)Clinical Experience (must have Education Agreement)Observation (if only observing, no hands-on)Refer to Nursing Nursing Students (Non-APRN Nursing Students) SectionNot Applicable

**If you are not a Nursing Student (Non-APRN Nursing Student), select Not Applicable for the two options below

Are you completing a capstone/practicum? *: Select YesNoNot Applicable Application Type - Nursing Students (Non-APRN Nursing Students) *: Select Observation (if the experience is only observation)Clinical Rotation - Completed Capstone/Practicum (must have Education Agreement)Clinical Rotation (must have Education Agreement)Not Applicable Brief description of your needs for clinical or observation experience: (Limit 500 characters)*

To look up office phone numbers to contact physicians with requests, please use our Physician Directory found here.

For questions on completing the above paperwork, please contact:

Organizational Development
Salina Regional Health Center
Phone: (785) 452-7333
Fax: (785) 452-7327
E-mail: orgdevstudents@srhc.com