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Parkview Education Services | Learning Opportunity Request Form
The information you submit will allow Parkview Health Education Services to match you or your cohort with the best learning experience we can offer through our system of healthcare opportunities. This form is used to request a learning experience that gains you credit through your school toward your degree program.
Submitting a request does not guarantee your placement in one of our learning opportunities
.
All requests MUST BE PART OF A COURSE REQUIREMENT.
All requests MUST BE SUBMITTED NO LATER THAN the date listed below for the next semester.
Placements are not guaranteed. Requests are matched with priority according to:
Priority Partner schools and Parkview Co-workers at those schools
Parkview Co-workers at non-partner schools
Northeast Indiana and Northwest Ohio Schools
Parkview Student Nurses (specific Parkview job program)
Non-partner schools as there are learning opportunities available and according to
Length of Partnership with School
Student's Placement History
Process for a learning opportunity placement:
Requests for a clinical, internship or other hands-on learning experience must be made online using this request form.
Parkview's Education Services Coordinator will work on finding a placement for the student(s) as there are placements available in the student's desired locations according to our match priorities listed above.
School/Student will receive confirmation or denial of placement according to the semester schedule below.
If confirmed, student(s) must return the Attestation Form and the Accepted Student form no less than 30 days prior to the start of the learning experience.
Failure to provide both completed forms will prevent the student from beginning at requested start date.
Questions?
Contact your Education Services Coordinator OR
Students@parkview.com
and in the subject line, provide the name of your school and type of learning opportunity requested.
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*
Your email
Parkview Education Services | College Experiences - Annual Calendar
Who is completing this form?
*
I am a student.
I am a school representative.
Your Full Name (First Name, Middle Initial, and Last Name)
*
Your answer
Your Email
*
Your answer
Your Phone Number
*
Your answer
Your School
*
NOTE: Our regional, higher-education partner schools are listed below with a *. Requests are matched according to partner schools first and then students from non-partner schools will be matched as there are opportunities available. If you are a non-regional school OR a High School not listed below, please enter your school name in "Other".
Anderson University*
Ball State*
Bethel University*
Goshen College
Grace College*
Huntington University*
IU Fort Wayne*
Indiana Tech*
Indiana Wesleyan University*
Ivy Tech*
Manchester University*
Northwest State (Ohio)*
Purdue Fort Wayne*
Purdue Global
Trine University*
University of Saint Francis*
Other:
What Semester is this placement request for? (NOTE: requests are only reviewed and placed one semester at a time according to the calendar above.)
*
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Spring
2025 - Summer
2025 - Fall
What type of student will be participating in the Learning Opportunity?
*
Certificate
Associates
Bachelors
Masters
Doctorate
Post-Doctorate
Other:
What type(s) of student are you requesting for?
*
CNA
LPN
ASN
BSN
ABSN
MSN
CRNA
Nurse Midwife
NP
Physician
PA
AA
MA
Surg Tech
Central Service Tech
PT
OT
SLP
ATC
Respiratory Therapy
Imaging/Radiology
Lab
Pharmacy
EMT
Paramedic
Dietary & Nutrition
Counseling
Psychology
Social Work
Other:
What is the Course Number and Name for which this student will receive credit?
*
Your answer
What Learning Opportunity(s) are you requesting?
*
Clinical - INDIVIDUAL - for credit, unpaid, hands-on learning opportunity in a clinical setting (hospital, healthcare facility, physician office, etc.)
Clinical - COHORT/GROUP - for credit, unpaid, hands-on learning opportunity in a clinical setting (hospital, healthcare facility, physician office, etc.)
Clinical - COHORT/GROUP + OBSERVATION - these are majority cohort/group placements with a few observation rotations happening on the same date/time
Other:
Is this course taught by an Instructor Gifted by Parkview to your school?
*
Yes
No
Unsure
Required Start Date for Learning Opportunity for Student(s)
*
MM
/
DD
/
YYYY
Required End Date for Learning Opportunity for Student(s)
*
MM
/
DD
/
YYYY
Are there any dates the student(s) will not be in the facility due to scheduled breaks, offsite training, etc.?
Your answer
How many students does this request represent? (Enter "1" if only you; Enter total # if a cohort/group).
*
Your answer
How would you qualify the level of experience of these students when they begin this Learning Opportunity?
*
No prior experience
Didactic work; no clinical experience
Didactic work and limited clinical experience
Didactic work and clinical experience; 2nd year+ student
What Parkview location(s) are you requesting placement at for this Learning Opportunity? (Check all that apply)
*
Parkview Regional Medical Center
Parkview Randallia Hospital
Parkview Ortho Hospital
Parkview Southwest
Parkview Bryan or facilities in Northwest Ohio
Parkview DeKalb Hospital
Parkview Huntington Hospital
Parkview LaGrange Hospital
Parkview Noble Hospital
Parkview Wabash Hospital
Parkview Warsaw
Parkview Whitley Hospital
Parkview Behavioral Health (including Park Center, Carriage House, etc.)
Parkview Cancer Institute
Parkview Heart Institute
Parkview Inverness Surgery Center
Parkview Premier Surgery Center
Parkview SurgeryONE (Observations Only)
Parkview Mirro Research & Education Center
Parkview Sports Medicine
Parkview Physicians Group - Indiana
Parkview Physicians Group - Ohio
Required
What Department/Unit/Specialty are you requesting placement at in this Facility? (Check all that apply)
*
Med/Surg
Ortho/Neuro/Trauma
STICU
MICU
CVICU
PICU
NICU
Family Birthing Center
Pediatrics
ED
OR
Respiratory
Lab
Pharmacy
Imaging/Radiology
Nutrition Services
Therapy (OT, PT, SLP, Rehab)
PPG - Hospitalists
PPG - Family Medicine/Practice
PPG - Women's Health
PPG - Behavioral Health
PPG - other
Other:
Required
How many TOTAL hours does each student need to complete during this Learning Opportunity (over the course of the semester or specific learning opportunity)?
*
Your answer
What days of the week is/are the student(s) AVAILABLE for the Learning Opportunity? (check all that apply)
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
N/A - Available All Days of the Week
Required
What type of day/time is available for the Learning Opportunity to be completed? Check all that apply.
*
Days
Evenings
Weekdays
Weekends
Required
What is the requested start time (of day) for the Learning Opportunity? Example: 0630
*
Your answer
What is the requested end time (of day) for the Learning Opportunity? Example: 1530
*
Your answer
Please provide any additional information that will help us successfully place the student(s). This may include the type of experiences and requirements for these students, a specific preceptor request, or state(s) the student(s) is licensed to practice in.
Your answer
CLICK SUBMIT TO COMPLETE REQUEST
As a reminder,
Submitting a request does not guarantee your placement in one of our learning opportunities
.
All requests MUST BE PART OF A COURSE REQUIREMENT.
All requests MUST BE SUBMITTED NO LATER THAN the date listed below for the next semester.
Requests are matched with priority according to :
Priority Partner schools and Parkview Co-workers at those schools
Parkview Co-workers at non-partner schools
Northeast Indiana and Northwest Ohio Schools
Parkview Student Nurses (specific Parkview job program)
Non-partner schools as there are learning opportunities available and according to Length of Partnership with School and Student's Placement History.
Process for a learning opportunity placement:
Requests for a clinical, internship or other hands-on learning experience must be made online using this request form.
Parkview's Education Services Coordinator will work on finding a placement for the student(s) as there are placements available in the student's desired locations according to our match priorities listed above.
School/Student will receive confirmation or denial of placement according to the semester schedule above.
If confirmed, student(s) must return the Attestation Form and the Accepted Student form no less than 30 days prior to the start of the learning experience.
Failure to provide both completed forms will prevent the student from beginning at requested start date.
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