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Clinical Rotation Request Form

Questions marked with a * are required
Hello and thank you for considering NMC Health for your clinical rotations. Please fill out the form once for each clinical rotation requested. 
Contact Information
Requested days of the week
Clinical first day
Clinical last day
School/University
Course name/number
Instructor name
Instructor phone
Please place some preferred times that work for you in the box below. There is no guarantee we can accommodate this.   
The number of students NMC Health will accomodate each day. Please make this number as accurate as possible.
What location are you requesting?
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