Nursing Student Request for Placement
Catalyst Medical Group - Valley Medical Center Division

Requesting Clinical Placement

Clinical placement must be requested through CMG/VMC Student Coordinator by completing the online application below. Please complete a separate application for each rotation.

Clinical Placement at CMG is not guaranteed for any student

Currently there are more student requests than nurses available to teach. Clinical placement decisions are based on multiple criteria. Priority placement is given to CMG employees and students that are seeking to find job placement in rural Idaho.

Application Deadline

30 days prior to clinical start date.

Affiliation Agreement

A current affiliation agreement must be in place between your school and CMG. To confirm if there is an agreement please contact your school coordinator.

Contacting Providers and Staff

Do not send mass communications to providers, nurses or staff at CMG requesting clinical placement. If you know a provider or nurse professionally or personally and would like to schedule a rotation with them please indicate their name on the application. CMG Student Coordinator will verify if they are available. Submission of your application signifies agreement with this stipulation.

Student Coordinator

Kary Lockart

208-298-3093

klockart@valleymedicalcenter.com

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* 1. Is financial reimbursement offered?

Yes

Other (please specify)

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* 2. Who is completing this request?

Student

Student Coordinator

Other (please specify)

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* 3. Student Contact Information

Student Name

City/Town

State/Province

ZIP/Postal Code

University Email Address

Phone Number

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* 4. Emergency Contact

Name

Phone Number

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* 5. Are you currently employed at CMG?

Yes

If yes, please list department and supervisor name:

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* 6. What type of program are you in?

LPN

Administrative Medical Assistant

Other (please specify)

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* 7. What year will you be for this clinical?

1st year

2nd year

Other (please specify)

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* 8. School Information

School Name

City/Town

State/Province

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* 9. Student Coordinator Contact Information

Name

City/Town

State/Province

Email Address

Phone Number

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* 10. Is this request for observation only?

Yes

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* 11. Specific dates of clinical rotation

Start Date

Date

End Date

Date

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* 12. Select all areas or population of preference for this clinical rotation (read your program requirements carefully to indicate qualifying areas for your rotation).

Adult/Gerontology

Cardiology

Emergency Medicine

Family Practice

Internal Medicine

Pediatrics

Psychiatry

Surgery

Urgent Care

Women's Health / OBGYN

Other (please specify)

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* 13. How many hours are needed for this clinical?

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* 14. Are there specific days of the week for the clinical? If no, leave blank.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Other (please specify)

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* 15. List the key objectives for this rotation

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* 16. Additional requests/ information

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* 17. Are there any specific requirements the preceptor must meet?

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* 18. Provide letter of introduction in the text box below including the following information: professional background, strengths, and career goals. Where do you call home? Where do you plan on seeking employment after graduation? What makes you an ideal candidate for this clinical placement and possible future employment at CMG?

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