Clinical Requirements

Listed below are the various forms required for clinical placements. All forms are in PDF format unless otherwise indicated. To save the form, right click on the link and choose "Save As" or "Save Link As."


General Requirements


Medical Records Checklist for Faculty – a list of required documentation for all clinical faculty members.


Health Form – All clinical faculty are required to complete the  immunization record


PPD Form - An annual PPD is required or an annual chest x-ray or a negative Quantiferon test result.  The attached form is for your convenience.


CPR Certification – Certified American Heart Association Health Care Provider Course Instructors


Required Self-study Modules (Bloodborne) - Submit the completion certificates for the bloodborne modules only.


Faculty Qualification Form - Please fill out the Faculty Qualification Form and sign it and submit it to Lisa Longeiret in room 2301.