Student Placement Coordinator Registration Form

For late registration of coordination funds:

Please fill out this form to apply for student placement coordination funds ($30,000) if your LTC home has not already registered for the funds on the enrollment form.

Select your LTC home from the list below. Please ensure the selection of the correct home and only select an LTC home once.

LTC Home

If you are unable to select your LTC home from the list, please contact us before continuing.

Email Address(Required)

Name(Required)

First Last

Would your long-term care home like to register for start-up or expansion funding for a student placement coordinator ($30,000 per LTC home to fund a 0.5 FTE)?(Required)

Yes, start-up funding to initiate a new student coordination role in your home

Yes, expansion funding to expand or improve the existing student coordination role(s) in your home

For student placements, does your LTC home have relationships with school boards, public colleges, private colleges, Indigenous Peoples Institutes or universities? (Select all that apply)(Required)

School boards

Public colleges

Private colleges

Indigenous Peoples Institutes

Universities

Not Applicable, our LTC home does not have relationships with schools

What orientation processes are in place for new students completing their clinical placements at your LTC home?* (Select all that apply)(Required)

Other: (Please describe)(Required)

Do you have an evaluation process in place to receive feedback from students and preceptors that participate in your student placement program?(Required)

Yes, we have a formal evaluation process.

Somewhat, we have an informal evaluation process.

No, we have no evaluation process.

How do you evaluate student placements in your LTC home? (Select all that apply)(Required)

Use a standardized tool created by our LTC home/Team members

Use an academic institution evaluation tool

Informal reporting process

What recruitment processes are in place at your LTC home for students who are completing their placements and will soon be entering the LTC workforce? (Select all that apply)(Required)

No recruitment process

Review job description/job posting

Focused job training for students in their last placement

Providing incentives (e.g. travel stipend)

Other:

Other: (Please describe)(Required)

In the past two years, has your LTC home hired a student(s) into a formal staff role who completed their placement at your LTC home? (i.e., hired a PN student who completed their clinical placement at your LTC home as an RPN after they have graduated) (Select all that apply)(Required)

PSW Student

PN Student

BScN Student

IEN

No, we have not hired a student(s) into a formal staff role in the past two years

What onboarding processes are in place at your LTC home for newly graduated students who are joining your staff as team members? (Select all that apply)(Required)

No formal process

Staff orientation

LTC home tour

Mandatory/Required Training(s)

Other:

Other: (Please describe)(Required)

What impact do you anticipate that funding for a Student Placement Coordinator will have on your LTC home’s ability to increase the number of PSW and nursing students you accept for clinical placements in 2023-2024?(Required)

0%-5% increase in PSW and nursing students

6%-10% increase in PSW and nursing students

11%-15% increase in PSW and nursing students

16%-20% increase in PSW and nursing students

21% or greater increase in PSW and nursing students

Not applicable, funding for a student placement coordination will not increase the number of PSW or nursing students our LTC home can accept in 2023-2024

What impact do you anticipate that funding for a Student Placement Coordinator will have on your LTC home’s ability to increase the number of PSW and nursing students who are hired as team members in 2023-2024?(Required)

0%-5% increase in students and IENs who are hired as team members

6%-10% increase in students and IENs who are hired as team members

11%-15% increase in students and IENs who are hired as team members

16%-20% increase in students and IENs who are hired as team members

21% or greater more increase in students and IENs who are hired as team members

Not applicable, funding for student placement coordination will not increase the number of students and IENs who are hired as team members by our LTC home in 2023-2024

What outside factors are preventing your home from taking in students?

Student Placement Coordinator Acknowledgement(Required)

I acknowledge that my home (as selected above) will use PREP LTC funding for coordination to start up or expand student placement coordination support.

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