Emory Midtown/Emory University/Winship Cancer Center


Student Information

  •  www.emoryhealthcare.org
    1. Click Careers
    2. Click Nursing at Emory
    3. Click Nursing Students & Faculty
    4. Click Student forms
      • Complete and submit Computer Logon Request Form

      • Complete and submit the HIPPA Form (1 page)

      • Complete and submit the Confidentiality Statement (1 page) (complete the following)
        1. Student Signature: Your Signature & Date
        2. Printed Students Name: Print your Name   Social Security Number: You Must write your full Social Security Number
        3. Name of School: Kennesaw State University
      • Complete and submit the Student Agreement (2 Pages)

        1. Enter day, month and year
        2. Signature: Your signature +Witness Signature: Have a class mate/ family member to sign as a witness
        3. Name: Print your name +Witness: Witness name printed
        4. Only submit 2nd Page of document  
      • Complete and submit the Authorization To Release Student Records Form (1 page)
        1. Enter day, month and year
        2. Signature: Your signature +Witness Signature: Have a class mate/ family member to sign as a witness
        3. Name: Print your name +Witness: Witness name printed

      • Emory University Hospital Midtown Only - Complete and submit the Parking Request (1 page)

        1. Must complete entire form to receive a parking pass for Emory Midtown
      • Emory John’s Creek Hospital Only – Complete and submit the Student Computer Access Request Form
        1. Complete all information above the *******************
      • 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. 
      • Log into your Advantage account and select Emory Health Care to view your results

Medical Documents that must be submitted with your clinical paperwork

 

  • Flu Vaccine for current flu season

Flu Vaccine is required for all students. For fall clinical rotations flu vaccine documentation is required by October 31st. For spring and summer clinical rotations flu vaccine documentation is required before clinical rotations start.

 

 

 

Document Checklist

 

HIPAA Form (1 page)

Confidentiality Statement (1 Page)

Student Agreement (submit 2nd page)

Authorization To Release Student Records (1Page)

Parking Request (Midtown Only)

Current Flu Vaccine

Computer Logon Request Form

Student Computer Access Request Form (John's Creek Only)