NIHT Clinical Placement Selection Form

NIHT Clinical Placement Selection Form
This form is required for all students enrolled in the Sleep Technology Essentials – 80-Hour Certificate Program.

The purpose of this form is to document how and where you will complete your 20 required clinical practice hours. Clinical hours may be completed either at the NIHT clinical site or at an approved clinical site in your home state.

Clinical hours may not begin until this form is submitted and, if applicable, clinical site approval is granted.
STUDENT FULL NAME*
Email*
example@example.com
Phone Number*

Area CodePhone Number
SECTION 2: CLINICAL PLACEMENT SELECTION
Cohort*
How will you complete your required 20 clinical practice hours?*

I will complete my clinical hours at the NIHT Clinical Site (National Sleep Solutions – Columbus, GA)I will complete my clinical hours at an approved clinical site in my home state
NIHT Clinical Scheduling Acknowledgment*

I understand that clinical scheduling at the NIHT site will be coordinated separately and is subject to availability.
Home State Clinical Placement Notice*

I understand that I am responsible for identifying a clinical site in your home state that meets NIHT requirements. Clinical hours may not begin until my proposed site is reviewed and approved by NIHT.I understand I will be required to complete a separate Clinical Site Request & Approval Form.

SECTION 2: CLINICAL PLACEMENT SELECTION