Student Forms

Undergraduate Forms

Certificate Forms

• Undergraduate Certificate Completion Form
• Undergraduate Certificate Intent Form

Program Forms

• 230 Level Student Clinical Performance Evaluation
• 251 Level Student Clinical Performance Evaluation
• 300 Level Student Clinical Performance Evaluation
• 400 Level Student Clinical Performance Evaluation
• NURS 495
• NURS 496
• Request for Assignment for International Study

RN to BSN Forms

• Credit by Portfolio Assessment for the licensed Registered Nurse
• NURS 417 / NURS 465 / NURS 475 Clinical Evaluation Form
• Remediation Plan (RN to BSN)
• Report of Student Initiated Contact for Academic Difficulty
• Undergraduate Certificate Completion Form
• Preceptor Approval Form
• RN to BSN Program Preceptor/Mentor Guide

Graduate Academic Advisement Forms

Questions regarding graduate academic advising forms can be directed to Xiao Sheng at 814-863-2211 or Khushi Patel at 717-531-4211

Advisement Forms

• Change of Adviser
• Change of NP Options
• Change Administrator/Educator to NP Option
• Change of NP to Administrator Option
• Change of NP to Educator Option

Ph.D. Forms

• Approval of Ph.D. Dissertation Research Proposal
• Funding Request for Dissertation Funding

Other Forms

• Curriculum Vitae Template
• Variable Credit Form
• Graduate Research Conference Travel Request

Nurse Administrator and Nurse Educator Preceptor Forms

All Practicum Courses

Please review the current MSN Handbook for practicum information.

N843

• N843 Preceptor Agreement Form
• N843 Practicum Log
• N843 Practicum Evaluation

N848

• N848 Preceptor Agreement Form
• N848 Practicum Log
• N848 Practicum Evaluation

Nurse Practitioner Forms: Family and Adult Gerontology (Acute and Primary Care)

All Nurse Practitioner Courses

• Alternative Clinical Experience Form
• Student, Preceptor, and Faculty Responsibilities
• NP Guidelines for Clinical Rotations
• Preceptor Agreement Form

N862

• N862 Preceptor Evaluation of Student Clinical Performance

N863

• N863 Preceptor Evaluation of Student Clinical Performance

N864

• N864 Preceptor Evaluation of Student Clinical Performance

N872/N872A

• N872 Preceptor Evaluation of Student Clinical Performance
• N872A Preceptor Evaluation of Student Clinical Performance

N873/N873A

• N873 Preceptor Evaluation of Student Clinical Performance
• N873A Preceptor Evaluation of Student Clinical Performance

N874/N874A

• N874 Preceptor Evaluation of Student Clinical Performance
• N874A Preceptor Evaluation of Student Clinical Performance

N876

• N876 Preceptor Evaluation of Student Clinical Performance