Faculty/ Instructor Information

Faculty/ Instructor Information
Name

First NameLast Name
Best Phone Number

Area CodePhone Number
Select School
Select School (if teaching at 2 different schools)
Select School (if teaching at 3 different schools)
Other School Name (if not listed previously)
Primary School E-Mail
Primary School Employee ID Number
Ohio Nursing License Number
Michigan Nursing License Number
New Orientation or Renewal?
If new instructors, what is your Starting Clinical Date?
Are you a current ProMedica employee?
If yes, what is your ProMedica ID Number?
ProMedica facility where you will be teaching:
Clinical Unit where you will be teaching (We need to know OB versus Acute Care for appropriate Epic class.)
ProMedica Instructor ID Number
Please email student@promedica.org for any questions. Thank you.
Should be Empty: