Request for BSN Clinical
Clinical Program of Study
If Clinical Program of Study is Other, please provide
Are You an Penn State Health Employee?
If yes, where do you work?
Number of Clinical Hours Requested
Describe the criteria of your request.
(Ex.: Type of clinical experience, but do not list objectives)
60 character limit: List clinical area or specialty only.
Requested Start Dates
Requested End Dates
School of Nursing Contact Information:
Clinical requests are granted for one academic semester or term. A continuation of a request requires another request form to be submitted and approved. Requests must be submitted at least two months prior to the requested start date.
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