Clincal facility approval application 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the school name and campus at the top of the form. Ensure that you select whether this application is for Vocational Nurse (VN) or Psychiatric Technician (PT) programs.
3. In section 1, provide the name and address of the clinical facility, including city, state, and zip code. Make sure to include a valid telephone and fax number.
4. Complete sections 2 through 5 with details about the facility administrator, director, contact person, and type of facility. This information is crucial for processing your application.
5. For section 6, indicate the license status by checking either 'Licensed' or 'Certified'.
6. In section 7, check all applicable client populations served by your facility.
7. Continue filling out sections regarding average daily census and available units/services for student assignments. Be thorough in providing accurate data.
8. Answer all questions in section 10 regarding clinical objectives and instructor availability. Your responses will help assess compliance with educational standards.
9. Ensure that all required documents are attached as specified in section 12 before submitting your application.
10. Finally, obtain necessary signatures from both the Facility Director and Program Director to confirm agreement with the contents of this form.

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