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Request a Preceptor Form

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Institution Information

Requirements

As the student, I acknowledge I have satisfied the required immunizations, drug screen and criminal background check and my Institution has on record:

Immunizations: Hepatitis B, MMR, Varicella, Pertussis, TB Skin Test (or Chest X-Ray) Flu. One of the following: 1) Verification of immunization, 2) Request for Religious Exemption from Influenza Vaccination, or 3) Request for Medical Exemption from Influenza Vaccination. Drug Screen, Criminal Background Check

Additionally, I recognize while I am conducting my clinical rotation that I will be required to:

Wear my University Student Name Badge in full view identifying me as a student. If you do not have a current University Student Name Badge you must be sure to have one made through your University before starting your clinical rotation.

Wear any uniform approved by my university or contact my preceptor to determine what is acceptable in the clinical rotation practice. (Uniform scrubs or business attire only. Absolutely no jeans are allowed.)

CHRISTUS Trinity Mother Frances reserves the right to decline any student’s request if the student does not meet the requirements outlined in the academic affiliation or if there is not an academic affiliation in place with the requesting student’s college or university. Additionally, Associates/Former Associates must be in Good Standing to be considered within the application process. We recommend that until you have confirmation you are accepted at CHRISTUS Trinity Mother Frances that you continue to evaluate alternative sites in other facilities. You will receive notification by the date listed for each semester. Upon acceptance, you will receive email notification from Education as well as orientation instructions.