Graduate/Post Graduate Nursing Precepted Experience Application Question Title * 1. Please provide your contact information: First Name Last Name Email Address Phone Number OK Question Title * 2. College of Nursing OK Question Title * 3. Program Administration Clinical Nurse Specialist Doctorate of Nursing Practice Education Family Nurse Practitioner Neonatal Nurse Practitioner Pediatric Nurse Practitioner - Acute Care Pediatric Nurse Practitioner - Mental Health Pediatric Nurse Practitioner - Primary Care OK Question Title * 4. Number of Clinical Hours Needed OK Question Title * 5. Clinical Start Date Date End Date Date OK Question Title * 6. As placement depends on the number of requests and available preceptors, are you willing and able to complete clinicals on weekends? Yes No OK Question Title * 7. Why are you interested in completing your clinical experience at Dayton Children's? OK Question Title * 8. Are you a current Dayton Children's employee? Yes No OK Question Title * 9. Comments (include anyone who has agreed to precept you) OK Question Title * 10. Please upload your current resume. Only PDF, DOC, DOCX files are supported - File size limit is 16MB. PDF, DOCX, DOC file types only. Choose File No file chosen Remove File Only PDF, DOC, DOCX files are supported - File size limit is 16MB. OK DONE