United States Department of Veterans Affairs
United States Department of Veterans Affairs

Portland VA Medical Center

Education - Regional Nursing Clinical Placement - Faculty Checklist

The first step is to make sure that the school is accredited and has an active affiliation  in place with the PVAMC.  If there is no such affiliation or if you are unsure, please contact Mr. Patrick Loop at (503) 220-8262 ext 57006.

Listed below are all the required forms and processes.

Steps 1-5: Faculty forms and procedures. Forms to be received in the PVAMC Education Office no later than 8 weeks prior to the first day of the clinical rotation.
Step 6: Student Forms and Checklist to be submitted a minimum of 6 weeks prior to the first day of the clinical rotation. Forms that are not submitted in a timely manner may jeopardize either the student and/or the instructor’s ability to attend clinical.

Step 1  Read and follow Clinical Access Policy for Undergraduate Student Nurses
Step 2  Read and follow Clinical Procedures for Undergraduate Student Nurses
Step 3 Instructor completes all of the below bulleted forms in ink and submits to the Education office (address below) 8 weeks prior to the first day of clinical rotation
Step 4  Instructor submits copies of the following bulleted items with required forms:
  • Copy of CV
  • Copy of BLS
  • Copy of Class syllabus with goals/objectives of clinical experience
Step 5 Approximately 2-4 weeks prior to your start date, an email will be sent to you explaining that you must now:
  • Schedule a fingerprinting appointment
  • Complete on-line orientation modules

These must be completed prior to your first day of rotation. The letter will explain whom to call and which modules to complete:
Step 6 Instructor completes Student Clinical Rotation Names list and submits together with all student forms & the instructor forms at least 6 weeks prior to first day of clinical rotation. The students' paperwork will not be processed without this form, which will jeopardize the student and/or instructor's ability to attend clinical.

  • Complete all forms listed above.

  • Please be sure to sign and date wherever required.

  • If you were not U.S. born, please include a photocopy of a citizenship document to show you are legal to be in the U.S., i.e.: naturalization certification, resident alien card, passport, etc. The photocopy must be legible.

  • Completed forms to be sent to:

Faculty Forms to be sent to: Student Forms & Checklists to be sent to:

Marlene Jamieson
Education Division (P2EDUC)
VA Medical Center
PO Box 1034
Portland, OR 97207

Questions:  503-220-8262  Ext 54747

Marlene Jamieson
Education Division (P2EDUC)
VA Medical Center
PO Box 1034
Portland, OR 97207

Questions call: 503 220-8262 Ext 54747



If you have any questions or concerns about the process or forms, please contact your instructor.

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