Welcome to the Clinical Student page
Fill out this form to request a Clinical Student expierence. Please allow up to 60 days to process application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Select the type of education expierence wanted.
*
Please Select
Clinical Student
Non-Clinical Student
Select your Institution
*
Please Select
ACSD 1
Baylor University
Capella University
Casper College
Chamberlain College of Nursing
College of Saint Mary
Concorde Career College
Concordia University St. Paul
Creighton University
Duquesne University
Eastern Wyoming College
Frontier Nursing University
Georgetown University
Gonzaga University
Grand Canyon University
Idaho State University
Iowa State University
Kansas State University
Laramie County Community College
Maryville University
Michigan State University
Montana State University, Billings City College
National Institute of First Assisting
Nightingale College
Purdue University Global
Rocky Mountain University of Health Professions
Rocky Vista University
Northern Wyoming Community College District
University of Arizona
University of Kentucky
University of Nebraska Medical Center
University of North Dakota
University of Northern Colorado
University of South Dakota
University of Utah
University of Wyoming
Valley Medical Center
Walden University
Western Governors University
Institution not in list
Type your Institution below
What type of student are you? (Ex: Med Student, Nursing Student, Social Worker etc)
Has an Ivinson provider/staff member approved your educational experience?
*
Yes
No
What is the name of the individual that approved your educational experience?
What is the Start and End date of your rotation?
Please explain why you want to do your clinical rotation at Ivinson
*
Submit
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