Designated Campus Colleague (DCC)

Application for Designated Campus Colleague (DCC)
A red asterisk * indicates required information
Applicant Name*

First NameLast Name
Applicant Email*
example@example.com
Applicant's CV / Resume *

Cancelof
Describe how you support the College of Nursing Mission: *
Examples: 1. Serve a a clinical preceptor for graduate nursing students, 2. Guest lecture in the undergraduate program, 3. Support nursing research in the following way...
As a DCC Associate I will primarily support:*

ANEW Grant (DNP)Bachelor of Science in Nursing (BSN)Master of Science for Entry to the Profession of Nursing (MEPN)Master of Science (MS) in Nursing (RN-MS)Doctor of Nursing Practice (DNP)Doctor of Philosophy in Nursing (PhD)Research & ScholarshipGlobal NursingOffice of Student & Academic Affairs (OSAA)Office of Learning & Healthcare Technology Innovations (LHTI)Business OfficeOther

All Designated Campus Colleague (DCC) applications require a College of Nursing (CON) sponsor. The CON sponsor will review the applicant’s resume / CV and application to determine how the applicant supports the Mission of the College of Nursing. After the sponsor reviews the DCC application, the application will route to the CON Human Resources Representative who will contact the applicant regarding next steps.

Select a sponsor that best aligns with your area of primary support and enter that name and email into the below required fields.

Area of Support	Sponsor Name	Sponsor Email
BSN	Melissa Goldsmith	mgoldsmi@arizona.edu
MEPN	Kelley Wilson	kwilsondnp@arizona.edu
RN-MS	Cheryl Lacasse	clacasse@arizona.edu
DNP	Valerie Kogut	vkogut@arizona.edu
DNP ANEW Grant	Valerie Kogut	vkogut@arizona.edu
PhD	Sheila Gephart	gepharts@arizona.edu
Research & Scholarship	Judith Gordon	judithg@arizona.edu
Global Nursing	Kathleen Insel	insel@arizona.edu
OSAA	Peggy Jenkins	pajenkins@arizona.edu
LHTI	Peg Kearney	pegkearney@arizona.edu
Business Office	Silvia Xu	silviaxu@arizona.edu

Sponsor Name*

First NameLast Name
Sponsor Email*
example@example.com
The CON Human Resources (HR) representative needs the below information to submit your DCC application to the University of Arizona. If the CON HR representative has any questions or needs additional information, they will contact you via email. To avoid delays in your approval as a DCC please respond to the HR representative promptly. Please review the DCC Self Service Guide regarding required steps to complete the DCC process for the University of Arizona.
Are you a US Citizen or Permanent Resident?*

YesNo
Date of Birth *

MonthDayYear
Gender*

FemaleMale
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a minor ( < 18 yrs old)?*

YesNo
If you are approved as a DCC with additional permission you can access UpToDate at no cost. Do you want permission to access UpToDate?*

YesNo

Have you previously:*

	Yes	No
Worked for the University of Arizona
Held an unpaid DCC appointment at the University of Arizona
Enrolled as an University of Arizona Student

Duties and or services performed: *

	Yes	No
Are you collaborating or performing services in the US?
Are you collaborating on research activities with University of Arizona faculty or research scientists?
My DCC duties will support the College of Nursing Mission

Most DCCs are required to complete Information Security Awareness training due to having access to University systems. Some roles may have additional training requirements if working with research or student data. By submitting this form, I understand that I may be required to complete one or more annual online trainings to retain my DCC status with the College.
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Application for Designated Campus Colleague (DCC)