Student Placement Requests

 The following request form will be used to submit requests for 2019 student placements with ATI Physical Therapy.  Please use this process to submit all of your 2019 requests for clinical rotations/internships. Please note that this is an initial request to place a hold on availability in your requested regions. Our team here at ATI will review all requests and will work diligently to reserve placements in your requested regions. 

Survey results are pulled every Monday and our team reviews requests submitted in the Monday to Sunday period prior to that. Our team will follow up with all requests within 14 business days to ensure your students are placed with the most appropriate Clinical Instructor and Clinic Location. Once we have confirmed all availability, our team will reach out to you to discuss your individual student details (contact information, areas of specialty interest, etc.). Once we have all student and CI information, our team will send updated, enhanced communications to you, your students and their CIs welcoming them to the program! 

 If you have any questions or additional inquiries, please do not hesitate to reach out to us directly at ClinicalRotation@atipt.com.  

Thank you and we look forward to partnering with you and your students! 

 

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is the name of your University?

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* 4. What is your role at the University?

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* 5. What state is your University in?

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* 6. What is your email address ?

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* 7. What is your phone number?

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* 8. Does your university have a current/active Clinical Affiliation Agreement with ATI for any of the following student types?

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* 9. Does your University currently use an electronic version of the Clinical Performance Instrument (CPI)?

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* 10. How many Clinical Rotations/Internships does your program have with a start date in 2019?

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* 11. What is your average class size?

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* 12. For your programs first clinical rotation/internship beginning in 2019, what year are the students?

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* 13. What type of students are you looking to place during this rotation?

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* 14. How many students are you looking to place at an ATI clinic during this rotation?

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* 15. What are the dates of this rotation?

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* 16. Please select the preferred geographical locations of this rotation.

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* 17. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 18. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 19. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 20. What type of students are you looking to place during this rotation?

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* 21. How many students are you looking to place at an ATI clinic during this rotation?

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* 22. What are the dates of this rotation?

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Date

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* 23. Please select the preferred geographical locations of this rotation.

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* 24. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 25. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 26. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 27. What type of students are you looking to place during this rotation?

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* 28. How many students are you looking to place at an ATI clinic during this rotation?

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* 29. What are the dates of this rotation?

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Date

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* 30. Please select the preferred geographical locations of this rotation.

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* 31. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 32. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 33. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 34. What type of students are you looking to place during this rotation?

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* 35. How many students are you looking to place at an ATI clinic during this rotation?

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* 36. What are the dates of this rotation?

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Date

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* 37. Please select the preferred geographical locations of this rotation.

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* 38. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 39. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 40. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 41. What type of students are you looking to place during this rotation?

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* 42. How many students are you looking to place at an ATI clinic during this rotation?

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* 43. What are the dates of this rotation?

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Date

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* 44. Please select the preferred geographical locations of this rotation.

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* 45. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 46. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 47. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 48. What type of students are you looking to place during this rotation?

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* 49. How many students are you looking to place at an ATI clinic during this rotation?

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* 50. What are the dates of this rotation?

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Date

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* 51. Please select the preferred geographical locations of this rotation.

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* 52. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 53. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 54. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 55. What type of students are you looking to place during this rotation?

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* 56. What are the dates of this rotation?

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Date

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* 57. How many students are you looking to place at an ATI clinic during this rotation?

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* 58. Please select the preferred geographical locations of this rotation.

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* 59. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 60. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 61. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 62. What type of students are you looking to place during this rotation?

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* 63. What are the dates of this rotation?

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Date

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* 64. How many students are you looking to place at an ATI clinic during this rotation?

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* 65. Please select the preferred geographical locations of this rotation.

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* 66. Please select any specialty areas of interest students in this rotation of your program may have.

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* 67. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 68. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 69. What type of students are you looking to place during this rotation?

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* 70. How many students are you looking to place at an ATI clinic during this rotation?

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* 71. What are the dates of this rotation?

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Date

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* 72. Please select the preferred geographical locations of this rotation.

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* 73. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 74. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 75. For your programs next clinical rotation beginning in 2019, what year are the students (if applicable)?

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* 76. What type of students are you looking to place during this rotation?

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* 77. How many students are you looking to place at an ATI clinic during this rotation?

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* 78. What are the dates of this rotation?

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Date

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* 79. Please select the preferred geographical locations of this rotation.

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* 80. Please select any specialty areas of interest students in this rotation of your program may have. 

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* 81. Please provide the name of any specific CI you would like to continue to partner your students with (if applicable).

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* 82. Is there anything else that would be beneficial for us to know about your placement request or program to provide better student engagement?

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