Skip to content

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
Student Name Type of student Actions
   

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

Acknowledgment(Required)
This field is for validation purposes and should be left unchanged.