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Student Nurse Externship Program

 

The University Hospital and Clinics Student Nurse Externship Program

Statement

1. I plan to take the Student Nurse Extern Program for academic credit.
2. After completion of the Spring 2018 semester, I will be within one year of graduation from an approved registered nurse program.

Name* 
Email
School of Nursing
Other Nursing School

Clinical Preference

To be completed by student applicant

Instructions to the Student:
1. Review Unit Descriptions
2. Select three areas where you would like to be a Student Nurse Extern and indicate your choices below. Choices must be for areas where you have had content or will have content in Spring 2018. (Example: If you will not have theoretical or clinical experience in pediatric nursing prior to the Student Nurse Extern program, you will not be able to work on a pediatric unit.)
Choice 1*
Choice 2*
Choice 3*

Verification of Content Covered in Theory

Place a check in the appropriate column below to indicate if content has been covered or will be covered in Spring 2018.

Obstetrical Nursing
Pediatric Nursing
Medical Nursing
Surgical Nursing
Mental Health/Psychiatric Nursing
Other:
 
Have you received UMMC EPIC Training?
The above information is true to the best of my knowledge.