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?
NIHT Clinical Scheduling Acknowledgment
Home State Clinical Placement Notice

SECTION 2: CLINICAL PLACEMENT SELECTION