Faculty/ Instructor Information
Name
*
First Name
Last Name
Best Phone Number
*
-
Area Code
Phone Number
Select School
*
Please Select
Baker College
Chamberlain
Firelands
Henry Ford
ITT Tech- Breckinridge
Jackson Community College
Kaplan
Lourdes University
Mercy College
Monroe Community College
Northwest State Community College
Ohio Northern University
Ohio University
Owens Community College
Professional Skills Institute
Siena Heights
Sylvania Public Schools
Terra Community College
Toledo School of Practical Nursing
University of Toledo
Other (see below to enter)
Select School (if teaching at 2 different schools)
Please Select
Baker
Chamberlain
Firelands
Henry Ford
ITT Tech- Breckinridge
Jackson Community College
Kaplan
Lourdes University
Mercy College
Monroe Community College
Northwest State Community College
Ohio Northern University
Ohio University
Owens Community College
Professional Skills Institute
Siena Heights
Sylvania Public Schools
Terra Community College
Toledo School of Practical Nursing
University of Toledo
Select School (if teaching at 3 different schools)
Please Select
Baker College
Chamberlain
Firelands
Henry Ford
ITT Tech- Breckinridge
Jackson Community College
Kaplan
Lourdes University
Mercy College
Monroe Community College
Northwest State Community College
Ohio Northern University
Ohio University
Owens Community College
Professional Skills Institute
Siena Heights
Sylvania Public Schools
Terra Community College
Toledo School of Practical Nursing
University of Toledo
Other school name if not listed above
Primary School E-mail
*
Primary School Employee ID Number
*
Ohio nursing license number
*
Michigan nursing license number
New Orientation or Renewal?
*
Please Select
New to ProMedica
Annual Renewal
New Instructors, starting clinical date:
Are you a current ProMedica employee?
*
Yes
No
If yes, ProMedica ID number:
ProMedica Facility where you will be teaching:
*
Please Select
Bay Park
Bixby/Herrick
Defiance
Flower
Fostoria
Fremont
Monroe
Toledo/Wildwood
Toledo Children's
Coldwater
Clinical Unit where you will be teaching (we need to know OB versus Acute care for appropriate Epic class)
ProMedica Instructor/Faculty ID Number, if known (starts with 88...)
Please email
nursing.student@promedica.org
for any questions. Thank you.
Submit
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