Undergraduate Practicum Students
For faculty and undergraduate practicum students
- Contingent Worker Form – (complete ONLY the section that reads, “Contingent Worker Information.” Your Social Security Number is required. Your home (or school’s) address should be written in the space that reads “Agency Address.” PLEASE DO NOT COMPLETE any of the other sections, do not enter any dates or statuses and do not sign the form. Incorrect or incomplete forms will not be accepted and you will need to resubmit. Please note: Computer access cannot be granted until this form is received.
- Contact Information Sheet
- Practicum Student Requirement Form
- Web-based Training Instructions/CHEX modules* - Please contact Shari Washington for information regarding web-based training and computer access.
: Once completed, please print completed forms and fax, email or hand-deliver all required documents to:
Shari L. Washington, MSN, RN-BC, CPN
Professional Development SpecialistPhone
: (202) 476-3523Email