PROGRAM COORDINATORS for College / Residency / Advanced Practice Providers

PRECLINICAL

STEP 1:  Complete the clinical/residency placement request process.

  1. You must have a current contract / educational agreement with the health care organization to proceed. If not already in existence, this may take several months so be sure to reach out early. Please check with your school/residency program reps to confirm your school/residency program has a current agreement with the health care organization.
  2. Complete the clinical / residency placement request form (Reviewed 6/28/2024). This Excel form has two sheets: 1) Preceptor Requests, 2) Groups with Instructor Requests. For preceptorships, requests should be submitted 10-12 weeks before the clinical start date. If you haven’t heard back in a reasonable amount of time, please contact the facility representative directly.
  3. Email the completed form to the clinical/rotation agency contact.
  4. If approved, continue to Step 2. If denied, the facility will contact you.

1. For all undergraduate nursing and medical assistant students, please use the AH website:
Nursing & MA Student Clinical Placement | Aurora Health Care

2. Questions regarding graduate level, non-clinical students (email):
ASC-ClinicalAffiliations@aah.org
Please review the AH website:
Advocate Aurora Student Projects/ Nursing Research | Aurora Health Care

STEP 2:  Complete the clinical/residency program placement process (after you receive approval).

  1. Complete and submit the affiliation verification (Updated 4/25/2025) form to the clinical agency contact. Form is to be submitted on or by the clinical/residency program start date.
  2. If required for placement, follow the appropriate process for computer training below.

    Advocate Aurora Medical Centers – Epic For all NON nursing student placements at Advocate Aurora – Effective 8/19/2024 we will have all students receive access to our Learning Management System “Workday.” Access will need to be entered by an Aurora employee. The following information will be needed to submit for Workday Access: Student’s Full Name including middle initial, DOB, last 4 of SS number, end date of the clinical, the student’s college email, and the student’s personal phone number. Once the access is granted, the student will need to complete the annual regulatory learning for that year they are at Aurora and must be completed yearly that they are on site.  Students should screen shot their completed transcript and send to their instructor for proof of completion.  This process will replace having the students view the onboarding modules off of this site.  The affiliation verification and confidentiality forms have been updated to reflect these changes. ***Epic access will be granted on a case-by-case basis. ***
    Advocate Aurora Epic Site-Specific Resource Updated 6/27/2025

    Emplify Health (Bellin Health) – Epic
    Epic & Pyxis Access Requests – Emplify Health Updated 7/9/2024 – Listed below are emails where Epic access requests can be sent.
    isaccess@emplifyhealth.org – Pyxis and glucose monitor requests also need to be requested at the same time and are included on the Epic email.
    Pyxis: Pyxis.Pharmacy@emplifyhealth.org 
    Glucose Monitor: Mindy.Mayo@emplifyhealth.org

    HSHS – Epic
    Epic & Pyxis Access Requests – HSHS and Prevea Updated 5/28/2025 – Listed below are emails where Epic access requests can be sent.
    HSHS Epic Site-specific Resource 12/15/2025
    HSHS Epic Student Instructor Co-sign Handout 7/31/2024
    HSHS Epic Student Nurse Clinical Instructor Outline 7/31/2024
    Epic Access, Epic Access, Identity and Access Management – HSHS-Identity_and_Access_Mgmt@hshs.org
    HSHS Gaining Student Epic Access Updated 11/22/2024

STEP 3: Complete the orientation modules.

Prior to working at a clinical site, the following orientation modules must be completed annually by students / residents / advanced practice providers / faculty. After completing all modules and you understand the information presented, complete, sign, and submit to your school or faculty member the confidentiality agreement and acknowledgement of orientation modules – (Reviewed 6/28/2024) form. The school will retain the signed/dated forms. Do not submit this form to the health care facility.

ORIENTATION MODULES:

VIDEO: UNDERSTANDING HIPAA – YOU NEED TO KNOW THE BOUNDARIES

POST CLINICAL

Advocate Aurora Health Care
Nursing students will complete the evaluation in myClinicalExchange.
Nursing Instructors: Evaluation

Bellin Health (Emplify Health)
Students are to complete this form and return it to their college instructor.  Faculty should submit the completed ‘Student Evaluation of the Clinical Experience (Group or Precepted)’ forms to the healthcare facility’s clinical site coordinator no later than TWO WEEKS after completion of the clinical. (Resident coordinators see ‘Residents’ webpage for ‘Evaluation of Rotation Site’ form to be completed by residents.)
Student Evaluation of the Clinical Experience (Group or Precepted) Reviewed 4/25/2025

HSHS
Below are HSHS QR codes for student (blue) and faculty (green) post clinical evaluations

FORMS

PRECLINICAL FORMS
Affiliation Verification Updated 4/25/2025
Background Approval Policy Updated 4/25/2025
Criminal Background Check Process Updated 4/25/2025
Clinical / Residency Placement Request Forms Updated 4/25/2025
Sheet 1:  Preceptor Requests
Sheet 2:  Groups with Instructors Requests
Confidentiality Agreement and Acknowledgement of Orientation Modules – Updated 4/25/2025
Hepatitis B Declination Updated 4/25/2025 – This form does not apply for Advocate Aurora.
Immunization & Health RequirementsUpdated 4/25/2025
New Instructor or New to Site Preclinical Checklist Updated 4/25/2025
DURING CLINICAL FORMS
Onsite Student / Advanced Practice Provider / Resident Orientation Checklist Updated 6/27/2025

Student Assignments
Bellin CollegeReviewed 4/25/2025
Lakeland UniversityNew 6/4/2024
NWTCReviewed 6/23/2023
Rasmussen UniversityReviewed 6/23/2023
UW – Green Bay Reviewed 6/23/2023

PRECEPTOR INFORMATION
RN Preceptor Handbook Updated 6/27/2025
Preceptor Agreement Reviewed 6/27/2025
Preceptor Evaluation of the Precepted Clinical Experience Reviewed 6/27/2025