Undergraduate Forms
Certificate Forms
BSN 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
- Student Evaluation of Preceptor/Mentor
- Preceptor Information Form
- Request for Assignment for International Study
RN to BSN Forms
- Agency Letter of Agreement
- Credit by Portfolio Assessment for the licensed Registered Nurse
- NURS 475 and NURS 495 Clinical Evaluation Form
- Student Evaluation of Preceptor/Mentor
- Preceptor Information Form
- Remediation Plan (RN to BSN)
- Report of Student Initiated Contact for Academic Difficulty
- RN to BSN Program Preceptor/Mentor Guide
Graduate Forms
Questions regarding these forms can be directed to Xiao Sheng at xus1@psu.edu or Khushi Patel at kbd5@psu.edu.
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
- Change Administrator to Educator Option
- Change Educator to Administrator Option
Nurse Practitioner Forms: Family and Adult Gerontology (Acute and Primary Care)
- NP Guidelines for Clinical Rotations
- Student, Preceptor, and Faculty Responsibilities
- Penn State NP Preceptor Agreement Form
- Preceptor Evaluation of Student Clinical Performance
- Preceptor Information FAQ [NONPF 2016]
- Alternative Clinical Experience Form
FACULTY USE ONLY
Nurse Administrator and Nurse Educator Forms
- Student Preceptor and Faculty Responsibilities
- Clinical/Practicum Site Affiliation Agreement Request Form
- Clinical/Practicum Student Log
- Student Evaluation of Preceptor/Mentor
Ph.D. Forms
Other Forms