Placement Request

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RN Nursing Pin

Baccalaureate of Science in Nursing: Clinical Placement Request

This form is to indicate for each of the NURS courses with a clinical component (NURS 327, NURS 400, NURS 449 and NURS 450) whether you are choosing:

  • the project option,
  • the LSEI "local" option,
  • the Preceptorship Agreement,
  • or requesting placement in a hospital listed here for which we currently have an Affiliation Agreement on file. The clinical request deadlines for affiliated facilities with BYU-Idaho are the following:
    • Fall - May 1st
    • Winter - September 30th
    • Spring - December 15th

All other requests (Preceptorship, Project, LSEI "local") are due

one week prior to the start of the semester.

Please follow the link and fill it out completely before submitting it. If you have any questions, please call the Nursing Outreach office at (208) 496-1281.

 

Name:                           
I-Number:                      
BYU-I Email:                  
Current RN Employer:   
Employed there since (i.e. July 2014):
Clinical or Project: Clinical Project

Southern East Idaho or Other Facility
Skip if you selected Project
SE Idaho Facility
Other Facility
(Please note that you will be coordinating your South Eastern Idaho clinical with your instructor during the first few weeks of the semester. Please refer to the Nursing Website)

Hospital Name:
Skip if you selected Project


Is this an Affiliated Facility, or a Preceptorship Agreement: (affiliated Facility is an Facility that has already been approved by BYU-Idaho. A list of affiliated facilities can be found at BYU-Idaho RN to BSN Affiliation Agreements)
Skip if you selected Project
Affiliated Facility
Preceptorship Agreement

Course Requiring the Clinical Hours (one course per request):
NUR 327
NUR 400
NUR 449
NUR 450

Semester Needed (i.e. Fall 2014):

Indicate the desired/required unit for clinical rotation and how many hours needed per unit:
Skip if you selected Project


Indicate your scheduling needs and availability (Try to be as flexible as possible):
Skip if you selected Project

Thank you for submitting your request.  Please read the following regarding your Preceptorship, Clinical, or Project Request.

Preceptorship Agreement

Be sure to have 2 original copies signed and mailed to the address at the bottom of the agreement in a timely manner.  If you have any questions about this process, please contact the Nursing Outreach Office (208) 496-1281 or nursingoutreach@byui.edu

Clinical Request

Placement requests are made with the education coordinator for that facility; notification of placement is often not received until the first week of the new semester.

Project Option

You will be coordinating this with your instructor during the first few weeks of the semester. (You still need to submit your request)