APP Student Placement Application

To apply for a rotation at one of our facilities, fill out and submit this form.
You should submit your application at least four to six months in advance of the rotation. Submitting a request does not guarantee placement.

If you are a clinical coordinator for a program and have already secured rotations for your students, please complete this APP Student Placement Template and email the spreadsheet to APPStudent@AtriumHealth.org.

Thank you for your interest in an APP Clinical Rotation with Atrium Health.

First Name Middle Name Last Name Email Primary Telephone Date of Birth (MM/DD/YYYY)

Atrium Health Teammate Yes No

Teammate Identification Number EID (if current Atrium Health teammate)

Have you completed a student clinical rotation at Atrium Health in the past? Yes No

Name of School/Program

If you do not see your school/program listed, we do not have a current CEAA. You are unable to complete a rotation at any Atrium Health practice or facility. Please do not complete the application.

Campus Location (Main, Online, or Name of Satellite Location) Student Type Student Type Other Name of Clinical Coordinator (If no clinical coordinator, please enter your program director.) Clinical Coordinator's Phone Number (If no clinical coordinator, please enter your program director’s phone number.) Clinical Coordinator's Email Address (If no clinical coordinator, please enter your program director’s email address.) Expected Graduation Date (MM/DD/YYYY)

Do you have a secured rotation? Yes No

Please list the preceptor's name, practice and address of the rotation. You will be asked to provide proof of the confirmed rotation. Select the practice/specialty area you need for your rotation If you selected other, please specify the specialty/practice area. Rotation Start Date Rotation End Date Number of Hours Needed

APP Student Placement Application

About Atrium Health

Careers

For Employees

For Providers

For Employers

Center for Advanced Practice

APP Student Placement Application

About Atrium Health

Careers

For Employees

For Providers

For Employers