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A unit of the University System of Georgia
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Forms & Links

The forms below are available in PDF format, which requires Adobe Acrobat Reader. Instructions for downloading and installing the Adobe Reader are available on the Adobe website. Click here for instructions on how to fill in form fields on-screen in Adobe using the Typewriter tool.

Clinical Placement Request Forms

ASN Forms

BSN Forms

Clinical Facilities - Orientation Materials

In order to place nursing students in medical facilities for their clinical experiences, there are online orientations, informational materials, and/or forms that must be completed by the student before they may attend clinical rotations. Clinical location and instructions are given to the students in their assignment packets each semester. It is extremely important that all forms be filled out completely and submitted to the clinical coordinator by the requested due date. Otherwise, students may lose their clinical spot and therefore will not be able to complete the requirements for the nursing course.

Please select your assigned facility from the list below for orientation instructions.

Children's Hospital of Atlanta

  • Core Orientation Materials
  • Required Forms:
    1. Pre-Clinical Orientation Checklist
    2. Orientation Module Assessment
    3. Medication Calculation Assessment
    4. Nursing Student Evaluation

Coliseum Health Systems, Macon

Coliseum Center for Behavioral Health, Macon

Grady Health Systems, Atlanta

  • All Orientation is thru ACEMAPP

McIntosh Trails/Pinewood Crisis Center, Barnesville

Medical Center Navicent Health, Macon

Monroe County Hospital, Forsyth

Piedmont Healthcare (Atlanta, Fayette, Henry, Newnan, Newton, Rockdale)

Riverwood Behavioral Health Systems. Riverdale

Southern Regional Medical Center, Riverdale

WellStar/Spalding Regional Hospital, Griffin

  • All Orientation thru ACEMAPP

Upson Regional Medical Center, Thomaston

  • All Orientation thru ACEMAPP