Faculty Forms

 

Faculty Evaluation Forms:

• Final Clinical Evaluation - First Year

  -Nurs 120, Nurs 130, Nurs 132

• Final Clinical Evaluation - Second Year
  -Nurs 220, Nurs 222, Nurs 230

• Faculty Evaluation of Clinical Facilities (to be completed every semester by all faculty)

• Final Preceptorship Evaluation (to be completed at the end of every semester by Nurs 235 faculty only)

• Nursing Faculty/Staff Resource Satisfaction Survey (to be completed at the end of every semester by all faculty)

 

Sim Lab Support Request Form:

• Simulation Request and Scenario Information

 

Other Forms:

• Remediation Form-Academic
• Remediation Form-Clinical
• Student Behavioral Contract
• Nursing Faculty Handbook 2021-2022
• Nursing Adjunct Faculty Handbook 2021-2022

Basic HIPAA Training 

Read HIPAA Privacy Basics & Intermediate Module, including Information Security Awareness (17 pages). Print HIPAA Privacy Post test and answer the questions. Fill in the date, your name, title (student), and submit to the Nursing Program Office.

 

Workers' Compensation Forms

To be completed by the student and instructor and returned to the Nursing Program Office immediately. Instructors are required to contact the course lead instructor or the Nursing Program office at the time the accident/injury/illness occurs. Students should have the form with them if being treated at the facility as secondary insurance. 

Anthem Accident Claim Verification Form