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

Student Clinical Education Placement Registration form {org_name}

This form is for LTC homes to fill out on behalf of students that completed supervised student placements at your LTC home.

Lead Contact Name

First Last

Lead Contact Email

Student Registration

Student Name	Type of student	Actions

There are no Students.

Please check the acknowledgement and click submit after you have registered all the students you would like to add at this time

Acknowledgment(Required)

I acknowledge that I am filling out this form for students that completed their clinical placement and was supervised by a team member at the LTC home noted at the top of this form.

Comments

This field is for validation purposes and should be left unchanged.