Registration – PREP LTC Students by Admin – Ontario CLRI PREP LTC Program

Student Clinical Education Placement Registration form Invalid Organization

Please register students to receive funding for your long-term care (LTC) home to host their supervised clinical placement(s).

Please only have one registration form open at a time and ensure that the name highlighted at the top of this form is for the correct LTC home. Submit this form before opening a new form.

Do NOT refresh this page before clicking Submit at the bottom of the form, otherwise you will lose any data you have entered.

Lead Contact Name

First Last

Lead Contact Email

Student Registration

Student Name	Type of Student (Select One)	Actions

There are no Students.

Please confirm the acknowledgement by clicking the box. Click submit after you have registered all the students you would like to add at this time.

This form can only register 25 students at a time. To register more students, please submit this form and then use your home’s unique link for student registration again to submit another group of students.

Acknowledgment(Required)

I acknowledge that I am filling out this form for students who are completing a clinical placement at the LTC home named at the top of the form.

Acknowledgment(Required)

I acknowledge that students registered in the program will have a placement end date that falls between April 1, 2026 and March 31, 2027.