Patient experience document 2026

1. Click ‘Get Form’ to open the Patient Care Experience Form in the editor.
2. Begin by entering your name in the 'Applicant Name' field. This identifies you as the applicant.
3. Input the last four digits of your Social Security number for verification purposes.
4. Fill in the 'Name of Facility' where you gained your experience, followed by the complete street address, city, state, and zip code.
5. Provide details about your supervisor by entering their name, title, and phone number.
6. Indicate whether your experience was paid or volunteer by selecting the appropriate option.
7. Enter the dates of your experience and total number of hours worked in the respective fields.
8. In the 'Describe Experience' section, provide a detailed account of your responsibilities and learning outcomes during this period.
9. Once completed, save your document. You can then email it as an attachment to graduate.admission@cuw.edu or print and fax it to (262) 243-3548.

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