Request for Student Clinical Placement
Step 2 of 7
Undergraduate
A current Affiliation Agreement must be on record between your School/University and the University of Pennsylvania Health System in order to request a nursing student clinical rotation. Undergraduate nursing students are required to complete these two steps:
- Complete the Request for Student Placement form and email/fax it to the respective liaison as listed below. Note that established and/or long-standing clinical rotations will take precedence over new requests.
- Complete HIPAA form
Requests should be received by no later than six (6) weeks prior to the requested clinical start date(s). Your request(s) will be acknowledged upon receipt and you may expect a response to your proposed request no later than four (4) weeks prior to the start of the clinical rotation
Graduate
It is the responsibility of the graduate nursing student to identify clinical preceptor and confirm start and stop dates. Graduate nursing students are required to complete these three steps:
- Complete the Graduate Nursing Student Information Form
- Complete HIPAA form
- Provide copy of Pennsylvania state license
Submit Completed Forms
Please fax or scan and email all items to the institution representative for which you are requesting:
Hospital of the University of Pennsylvania/CPUP
Cynthia Richardson MSN, RN
cynthia.richardson@uphs.upenn.edu
Fax: 215-662-6069
Phone: 215-662-6514
Pennsylvania Hospital
David O'Brien MSN, RN
daobri@pahosp.com
Fax: 215-829-8757
Phone: 215-829-8457
Penn Presbyterian Medical Center
Barbara Anderson MSN, RN
barbara.anderson@uphs.upenn.edu
Fax: 215-662-9179
Phone: 215-662-8610
Good Shepherd Penn Partners
Linda Stevenson MSN, RN
linda.stevenson@uphs.upenn.edu
Fax: 215-893-2555
Phone: 267-252-3692
Penn Care at Home & Hospice
Christine Bossone, MSN, RN
christine.bossone@uphs.upenn.edu
Fax: 610-747-3489
Phone: 610-747-3400
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