The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

m7HxMa5EVAecdgUcqiGrxv7JqdTTSxiLLnyQ5uNWYJAVeRx5tRH6IGxRFEMKWfKcUV7M4iHJb8AtZKHacRiqNas4XEuEuEtxoLy3MpPmUKdvJVokqk3nFeYF

Compliance Request

Clinical/Internship Experience Placement Request.

WCU Academic Agreements and Compliance Operations Office works with third party vendor Castle Branch to approve student placement requirements for all clinical/internship/field experiences.

After a placement site has been confirmed, program coordinators need to provide the following information related to the WCU student or cohort and the affiliated placement site.

WCU Office of Academic Agreements & Compliance Operations will review the Affiliation Agreement terms with the placement site and identify the compliance package WCU students will need to obtain for their placement.

College

* must provide value

Academic Program:

* must provide value

Program Coordinator Email:

* must provide value

Is this compliance request for:

* must provide value

An Individual Student

Class Cohort (group of students at ONE site)

Submit Class Roster (list of students at DIFFERENT sites)

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Student First Name:

* must provide value

Student Last Name:

* must provide value

WCU Student email:

* must provide value

Is this the FIRST time ______ ______ is completing a clinical/internship experience?

Yes - first time placement

No - Returning student (looking to renew a compliance package)

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Provide cohort course (i.e. NSG 411)

Upload Course Roster:

MUST include the following for each student in the cohort/course:

First Name
Last Name
Student WCU Email
Anticipated Start Date
Placement Site Name

Upload file

Anticipated Start Date of Placement:

* must provide value

M-D-Y

Is the placement site known?

Yes

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Is this placement occurring on WCU campus?

Yes

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Are there multiple placement sites the student will be rotating in the same academic year?

Yes

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Provide name of placement site:

Is this Music Therapy placement for fall or spring?

Fall

Spring

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MT Fall Site:

MT Spring Site:

Please indicate if SMD student is in their 1st or 2nd year of AT clinicals:

1st year

2nd year

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SMD AT Summer Site:

SMD AT Fall Site:

SMD AT Spring Site:

NTD site #1:

NTD site #2:

NTD site #3:

NTD site #4:

NTD site #5:

NTD site #6:

CSD Spring Placement (school setting)

CSD Summer Placement (medical setting)

Optional: Provide additional notes/comments about the student placement.

Expand

You have identified a confirmed placement for ______ ______ at ______.

This request will be processed to include both the ______ program requirements and any additional affiliation agreement requirements for ______.

You have NOT identified a confirmed placement site.

Students without a confirmed site should still initiate the process with the vendor to obtain their base ______ compliance package. Once program/student confirms placement site, site information MUST be submitted for review and affiliation agreement status and additional requirements as needed.

This request will be PENDING APPROVAL until a confirmed site is identified.

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