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

Question Title

* 1. Name

Question Title

* 2. Truman Employee Number

Question Title

* 3. BSN graduation date

Question Title

* 4. Name of current school

Question Title

* 5. Type of Program

Question Title

* 6. How many courses have you taken?

Question Title

* 7. Name of Instructor:

Question Title

* 8. Name of Course: 

Question Title

* 9. Type of experience / project:

Question Title

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

Question Title

* 11. Number of hours needed

Question Title

* 12. Date range to complete hours

Question Title

* 13. Preference for areas to be placed:

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

Question Title

* 14. Are you currently employed?

Question Title

* 15. Are you a Truman Medical Centers employee?

Question Title

* 16. What is your employee ID number?

Question Title

* 17. Expected graduation date

Date

Question Title

* 18. Email:

Question Title

* 19. Phone:

Question Title

* 20. Director letter of good standing

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

Question Title

* 21. I, the student, confirm that i have read the placement informational sheet and understand the information within including that regarding placement and notification deadlines. Additionally, I understand that placement is never guaranteed. Please submit electronic signature.

T