TCPS Partner Profile 2011-2012

1. Partner Profile

Welcome to the Tennessee Clinical Placement System (TCPS)! Please provide us with the following information so we can begin processing your partnership information. Thank you!

*
1. Organization's official name.
(The official name as used on your official correspondence, websites, etc.)

Organization's official name. (The official name as used on your official correspondence, websites, etc.)

2. If your organization is a system and partnership will cover more than one facility or school (program of study), list the facilities/programs of study below.

If your organization is a system and partnership will cover more than one facility or school (program of study), list the facilities/programs of study below.

*
3. Organization's address and contact information:

Organization's address and contact information: Street Address:

City/Town:
State:
ZIP/Postal Code:
Area Code & Phone Number
Area Code & Fax Number:

4. Your County if in Tennessee

Your County if in Tennessee

*
5. Which TCPS Region(s) would be most appropriate for you to join? Each region is centered at a metropolitan hub and extends outward. More rural areas may request multiple regional partnerships if needed based upon historical student/facility interaction.

Which TCPS Region(s) would be most appropriate for you to join? Each region is centered at a metropolitan hub and extends outward. More rural areas may request multiple regional partnerships if needed based upon historical student/facility interaction. MIDDLE (NASHVILLE)

MIDWEST (JACKSON)

EAST (KNOXVILLE)

SOUTHEAST (CHATTANOOGA)

WEST (MEMPHIS)

CUMBERLAND (COOKEVILLE/CROSSVILLE - Currently developing)

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6. Type of Partner Organization:

Type of Partner Organization: School

Clinical Facility

TCPS Partner Profile 2011-2012

1. Partner Profile

*1. Organization's official name. (The official name as used on your official correspondence, websites, etc.)

2. If your organization is a system and partnership will cover more than one facility or school (program of study), list the facilities/programs of study below.

*3. Organization's address and contact information:

4. Your County if in Tennessee

*5. Which TCPS Region(s) would be most appropriate for you to join? Each region is centered at a metropolitan hub and extends outward. More rural areas may request multiple regional partnerships if needed based upon historical student/facility interaction.

*6. Type of Partner Organization:

*
1. Organization's official name.
(The official name as used on your official correspondence, websites, etc.)

*
3. Organization's address and contact information:

*
5. Which TCPS Region(s) would be most appropriate for you to join? Each region is centered at a metropolitan hub and extends outward. More rural areas may request multiple regional partnerships if needed based upon historical student/facility interaction.

*
6. Type of Partner Organization: