Please be aware: forms that are not appropriately completed at the time of submission will not be considered. Additionally, the application and notification deadlines indicated below are FIRM. Exceptions will not be made. One form should be submitted for each semester the student is seeking placement. 
 
Summer Placement:      Application: Dec. 1, Notification: Jan. 15
Fall Placement:              Application: Mar. 1, Notification: Apr. 1
Spring Placement:         Application: Aug. 1, Notification: Sep. 1

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* 1. Name (include middle initial or application is not valid)

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* 2. Truman Employee Number

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* 3. Date of Hire

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* 4. FTE Status

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* 5. Current Unit

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* 6. Current Role

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* 7. BSN graduation date

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* 8. Name of current school

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* 9. Type of Program

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* 10. How many courses have you taken?

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* 11. Name of Instructor:

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* 12. Name of Course: 

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* 13. Type of experience / project:

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* 14. What semester and year are you requesting (check one)

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* 15. Number of hours needed

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* 16. Date range to complete hours

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* 17. Preference for areas to be placed:

Complete thoroughly. No changes to student assignments will be made after decisions reached.

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* 18. Expected graduation date

Date

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* 19. Email:

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* 20. Phone:

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* 21. Director letter of good standing

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 22. I, the student, confirm that I have read the placement informational FAQ sheet and understand the information within including that regarding placement and notification deadlines. Additionally, I understand that placement is never guaranteed. Lastly, to be eligible, employee/student must have successfully completed hospital orientation and onboarding. Please submit electronic signature.

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