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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.

Lead Contact Name
Student Name Type of Student (Select One) Actions
   

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)