DNP Clinical Forms

DNP Overview and Clinical Preceptor Info

Exxat Instructions

Covid: Assumption of Risk Form

DNP Student Information Request Form

DNP Preceptor Information Request Form

DNP Employer Acknowledgement Form

DNP Clinical Documentation Checklist

Clinical Student Request & Authorization to Release Records and/or Info.

Initial Clinical Health Clearance Form

Drug Screening and Testing

Re-Clearance Clinical Health Form

DNP Clinical End Evaluation of the Preceptor Form

DNP Clinical Evaluation Form of the Clinical Site

DNP Project Rubric

All clinical clearance documentation requirements are due 14 days prior to the start of the clinical course. If a student is not cleared 7 days prior to the start of the first day of their clinical course, they will be administratively dropped without warning (NO EXCEPTIONS).

REQUIREMENTS PRIOR TO CLINICAL COURSES - All students need to have completed:

1. Submission/approval of Student & Preceptor Information Request Forms
2. Completion of signed Confirmation of Clinical Placement Form - Signed & returned by preceptor
3. Completed contract if required by agency. Signed by facility & university
4. Health clearance through EXXAT - Student needs to be cleared by EXXAT with submission of COVID vaccine/religious exemption*
5. Completed Urine Drug Screen - Result of "APPROVED" through Universal
6. Completed Background Check - Result of "APPROVED" through Universal


*Religious exemption of COVID 19 vaccine needs to be approved by practicum site prior to start of clinical hours


Exxat, urine drug screen, and criminal background check  Due May 8, 2023
FALL 2023 SPRING 2023
Exxat August 14, 2023 January 3, 2022
Urine Drug Screening and Criminal Background Check (Universal) August 14, 2023 January 3, 2022
Influenza vaccination October 3, 2023 January 3, 2022