Student Placement Request Form

Welcome to Student Placement! We are thrilled to have students complete their practicums/preceptorships at VUMC in various clinical practice areas, with a focus in advanced practice, nursing education, leadership, informatics, etc.


Students, including current VUMC staff, please submit this placement request form according to the deadlines outlined on our website.


Forms received following the deadlines may result in delayed start dates for approved rotations.


Please do not submit more than one form with the same placement request information. This could delay onboarding and consideration for placement.

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Please note, if your school name is not listed above,

VUMC does not have a current affiliation agreement

with your institution and 6-8 weeks will be required

to establish this agreement.

Contact to establish an Affiliation Agreement.


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Please list:

Name of Preceptor

Preceptor Work Area


If you have NOT identified a preceptor:

Please know that the availability of preceptors is limited and based on your request and verification of preceptor willingness and availability.


Please DO NOT submit this survey.

If you have any further questions, please do not hesitate to contact us at student.placement@vumc.org.

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Please list your preceptor's VUMC Email Address. Please refrain from listing their personal email address.

Do you have a preferred preceptor?*

Include preceptor information pertinent to the clinical area of interest. Please do not include multiple preceptors from separate clinical areas in one form (i.e., ED and Trauma). A new form must be submitted for each clinical area of interest.


Please list:

Name of Preceptor

Preceptor Work Area

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Please refrain from listing their personal email address.

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Do you have a 2nd preferred preceptor?*

Please list:

Name of Preceptor

Preceptor Work Area

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Please refrain from listing their personal email address.

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Research or quality improvement project required?*

Any human subjects research that takes place at VUMC will need to be submitted to the VUMC IRB.

Please review the Research IRB Instructions for further information. **Please right click link and open in new window**

Facility*
Inpatient or Outpatient Experience (preference)*
VUH Area of Placement*

If your request is within the OR, please select perioperative services.

Monroe Carell Jr. Area of Placement*

If your request is within the OR, please select perioperative services.

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VMG Area of Placement*
VPH Area of Placement*
VWCH Area of Placement*
VBCH Area of Placement*
VTHH Area of Placement*
Do you have a school issued ID badge?*
Are you a current VUMC employee? *

Not your employee ID

The individual from your school that is responsible for verifying students meet facility compliance requirements

Please provide email address only (i.e. coordinator@school.edu).

  • Cover Letter and Resume
  • Unofficial Transcript (from current program)
  • Must be a complete unofficial transcript PDF, not copied to a word document or other form of documentation
  • Full name included
  • Grades for all semesters, including at least two semesters prior to semester of placement need.
  • Course syllabus for this rotation, if available.
Drag and drop files here or