Student Clinical Placement Form

Please note: You must have a secured preceptor before completing this form.

Please complete the form to initiate the process for a clinical placement at SSM Health. We are only able to place students who have secured a preceptor.

Important Notes:

The deadline to apply for clinical placement is 6-8 weeks prior to start date.
Your request does not guarantee placement.

Are you a current SSM Health employee? Yes No

In what region will the rotation occur?

(i.e. DePaul, Shawnee, Medical Group, Mt. Vernon, Health at Home, St. Mary's Hospital - Madison)

(i.e. Med-Surg, Pediatrics, Internal Medicine, Behavioral Health)

format: mm/dd/yyyy

Student Clinical Placement Form

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