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Essay, Nursing, Pages: 1

Practicum Site Information Form

Practicum Site Information Form

STUDENT INFORMATION

Student name:

Student phone number (primary):

City/town:

State:

Walden email address:

Alternative email address:

Time zone: MST

Student practicum site schedule: see below*: Practicum Site Information Form

PRECEPTOR AND SITE INFORMATION

Preceptor name (first and last):

Preceptor credentials (MD, FNP, DO, etc.):

Site name:

Site address

City/town:

State:  Arizona

Preceptor email address

Preceptor phone number:

Site phone number:

Field Site Clinic hours: Thursdays and Fridays for the next ten weeks. The clinical hours will be from 9:00 AM to 5:00 PM.

March:  6th, 7th, 13th, 14th, 20th, 21st, 27th,28th,

April: 3rd, 4th,10th, 11th ,17th, 18th, 24th, 25th,

May: 1st, 2nd, 8th, 9th

*You must have specific dates and times, please provide a calendar with your dates and times written in the days of the week.  We must be able to verify the exact dates you are in practicum setting.  We must be able to see you will meet your hour requirements including holidays off: Simply stating every Monday for 8 hours will not be acceptable.

Month#1: March

Clinical Week Time (Thursday) Time (Friday)
CW-1 (6th-7th)) 9am-5pm 9am-5pm
CW-2(13th-14th) 9am-5pm 9am-5pm
CW-3(20th- 21st) 9am-5pm 9am-5pm
CW-4(27th-28th) 9am-5pm 9am-5pm

 Month#2: April

Time (Thursday) Time (Friday)
CW-5 (3rd -4th) 9am-5pm 9am-5pm
CW-6 (10th-11th) 9am-5pm 9am-5pm
CW-7 (17th-18th) 9am-5pm 9am-5pm
CW-8 (24th-27th) 9am-5pm 9am-5pm

Month#3: May

Time  (Thursday) Time (Friday)
CW- 9 (1st-2nd) 9am-5pm 9am-5pm
CW-10 (8th-9th) 9am-5pm 9am-5pm

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Question

Practicum Site Information

Prior to starting the course, you should have applied for a practicum site following the guidelines for psychiatric-mental health nurse practitioner (PMHNP) practice. Now it is time to make it official. For this Assignment, you provide your Clinical Faculty with information about your practicum site, your Preceptor, and your clinical calendar.

To Prepare

  • Verify that your practicum application has been approved by logging in to Meditrek.
  • Access the Practicum Site Information Form from the Learning Resources.

The Assignment
Complete the designated areas of the Practicum Site Information Form. Include your practicum site and contact information; your Preceptor and contact information; and a schedule of when you plan to engage in onsite practicum activities.

Students must provide their schedule in the form of a monthly calendar with the time written out on the appropriate date. For example, writing 8 hours on the 5th day of the monthly calendar slot is not acceptable. You must enter 8am-4pm or 10pm-6pm in the day slot of the monthly calendar. Students need to complete the calendar for the whole quarter to demonstrate to the faculty the total number of hours to be completed this quarter.

NOTE: Students have a responsibility to notify faculty of any schedule changes throughout the quarter.

Practicum Site Information Form

Practicum Site Information Form

By Day 7 of Week 1
Submit your completed Practicum Site Information Form.

submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  • To submit your completed assignment, save your Assignment as WK1Assgn 1_LastName_Firstinitial
  • Then, click on Start Assignment near the top of the page.
  • Next, click on Upload File and select Submit Assignment for review.
Client’s Notes:
  • Helo. i will put the site information. For the calendar , Do Thursday and friday 9am-5pm. Starting from next week for the next 10 weeks.