If you have already completed part of the survey, you may continue where you left off.
All you need is the return code given to you previously. Click the link below to begin entering
your return code and continue the survey.
Please complete this secure form. All of your answers are confidential and used internally for practice agreement with our legal team and reporting to the Accreditation Commission, CCNE and Kansas State Board of Nursing.
Please note the student may not begin this clinical rotation until this form is submitted and our Placement Coordinator has verified a contract is in place with your facility.
If you have any questions, please contact Carmen Carter, Senior Coordinator Practice Placement, firstname.lastname@example.org.
The University of Kansas School of Nursing Faculty and Staff
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