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:
  1. Priority Partner schools and Parkview Co-workers at those schools
  2. Parkview Co-workers at non-partner schools
  3. Northeast Indiana and Northwest Ohio Schools
  4. Parkview Student Nurses (specific Parkview job program)
  5. 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:
  1. Requests for a clinical, internship or other hands-on learning experience must be made online using this request form.
  2. 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.
  3. School/Student will receive confirmation or denial of placement according to the semester schedule below.
  4. 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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Email *
Parkview Education Services | College Experiences - Annual Calendar
Who is completing this form? *
Your Full Name (First Name, Middle Initial, and Last Name) *
Your Email *
Your Phone Number *
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".
What Semester is this placement request for? (NOTE: requests are only reviewed and placed one semester at a time according to the calendar above.) *
What type of student will be participating in the Learning Opportunity? *
What type(s) of student are you requesting for? *
What is the Course Number and Name for which this student will receive credit? *
What Learning Opportunity(s) are you requesting? *
Is this course taught by an Instructor Gifted by Parkview to your school? *
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.?
How many students does this request represent? (Enter "1" if only you; Enter total # if a cohort/group). *
How would you qualify the level of experience of these students when they begin this Learning Opportunity? *
What Parkview location(s) are you requesting placement at for this Learning Opportunity? (Check all that apply) *
Required
What Department/Unit/Specialty are you requesting placement at in this Facility? (Check all that apply) *
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)? *
What days of the week is/are the student(s) AVAILABLE for the Learning Opportunity? (check all that apply) *
Required
What type of day/time is available for the Learning Opportunity to be completed? Check all that apply. *
Required
What is the requested start time (of day) for the Learning Opportunity? Example: 0630 *
What is the requested end time (of day) for the Learning Opportunity? Example: 1530 *
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.
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 :
  1. Priority Partner schools and Parkview Co-workers at those schools
  2. Parkview Co-workers at non-partner schools
  3. Northeast Indiana and Northwest Ohio Schools
  4. Parkview Student Nurses (specific Parkview job program)
  5. 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:
  1. Requests for a clinical, internship or other hands-on learning experience must be made online using this request form.
  2. 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.
  3. School/Student will receive confirmation or denial of placement according to the semester schedule above.
  4. 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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