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Patient experience document 2026
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- Click ‘Get Form’ to open the Patient Care Experience Form in the editor.
- Begin by entering your name in the 'Applicant Name' field. This identifies you as the applicant.
- Input the last four digits of your Social Security number for verification purposes.
- Fill in the 'Name of Facility' where you gained your experience, followed by the complete street address, city, state, and zip code.
- Provide details about your supervisor by entering their name, title, and phone number.
- Indicate whether your experience was paid or volunteer by selecting the appropriate option.
- Enter the dates of your experience and total number of hours worked in the respective fields.
- In the 'Describe Experience' section, provide a detailed account of your responsibilities and learning outcomes during this period.
- 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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