Cartersville Medical Center

Faculty Information

  • Complete Agreement Concerning Faculty Supervision of Clinical Training  

  • Complete Educational Training Program Agreement
  • Complete Confidentiality Form
  • Complete Acknowledgment of HIPAA
  • Complete and submit Attestation Form for Contract/Agency/Student Personnel. Complete the following:
      • Employee’s Name: Your Name
      • BLS Expiration Date: Expiration Date off your CPR card
      • Last TB/PPD Assessment Date: Last ppd date within 90 days
      • Hepatitis B Vaccine: 1st Hepatitis date on your physical or titer date
      • Information Security Agreement Signed (2nd Page): Date you signed the Confidentiality and Security agreement
  • Must have flu vaccine for current flu season.  Fall semester flu documentation must be submitted by 2nd Friday in October – Spring semester flu documentation must be submitted with clinical paperwork. 
  • All instructors must have a Background Check & Drug Screening through Advantage  The fee for this service is $97.00. Background Check & Drug Screening must be completed at least two weeks before the first day of clinical.   Forward e-mailed Advantage payment receipt to for reimbursement.
  • E-mail your drug and background screening from Advantage Students to Lori Smola @ in the email subject line: KSU Drug & Background Check
  • Please contact Lori Smola @ to set up an appointment for badges & orientation fifteen days before your clinical start date.  Orientation will not be held the first or last week in the month.
  • Submit completed forms to room HS 3004 or e-mail to or fax 470-578-9069