NR478 Community Health Nursing Practicum Plans
Starting Summer Term 2, 2012, students may no longer self-register for the NR478 Community Health Nursing Practicum. The Online Practicum Coordinator, Sue Sciacca, will register a student for NR478 once all of the requirements for clinical course enrollment have been satisfied. Students interested in enrolling in NR478 should complete the requirements for clinical course enrollment, fill in the information below and email this form as a file attachment to Sue Sciacca at This is a Word document so you may type directly on this form.
Student Name:
Regis ID#:
Term and Semester Plan to Enroll in NR478:
Requirement for Clinical Course Enrollment / Yes/Completed(Place X in boxes completed) / Not Applicable
(Place X in boxes no applicable)
Students who are Colorado or Arkansas residents(Before you contact anyone at any site contact via email the Online Practicum Coordinator at for coordination of your request)
Student’s NR466R course faculty has approved student’s choice of community clinical agency (Clinical site is a community site generally outside of a hospital or office)
Appropriate community clinical agency has granted permission for student to complete practicum at the agency
Appropriate potential preceptor identified (BSN prepared nurse in a nursing role at the site)
All of student’s compliance documents are on file with the College (See the Syllabus and Week 1 Learning Activities for details of these requirements)
Student has verified with the appropriate agency contact person if the clinical agency requires a contract--Regis University Contract or affiliation agreement--with Regis (This is NOT the same as the Preceptor Agreement and your preceptor may not know. Ask the agency contact person to verify with their agency or the agency's Education Department if a contract is required. If a contract is required, initiate this process immediately by completing the request form at:
This process may take 6-8 weeks so request the contract immediately and check every two weeks to determine if it has been completed. If a contract with Regis University is not required by the clinical agency, then confirmation by the agency that you are able touse the site for your NR478 Practicum is required)
If Regis University Contract or Affiliation Agreement required by clinical agency, student has submitted a request for a contract at:
If student submitted a request for a contract, identify the date contract request submitted / Date contract request submitted:
My electronic signature below indicates all information is complete and accurate:
______
Electronic SignatureDate