MS Practicum Application - Home | NYU College of Nursing

New York University
College of Nursing Master’s Programs
PRACTICUM APPLICATION FOR CLINICAL COURSES WITH A CLINICAL COMPONENT
Course Name: __________________________________ Course No. _______________Year:______________
 APN Adult Acute Care
 APN Adult Primary Care
 APN Family
 APN Mental Health
 APN Pediatrics
Semester
 Fall
 Nurse-Midwifery
 Substance Related Disorders
 Palliative Care
 Holistic Nursing
 Geriatrics (post-masters)
 Nursing Informatics
 Nursing Education
 Nursing Administration
 Dual Degree MS Nsg/MS Mgt
 Dual MS/MPH (Global Public Health)
 Spring
 Summer
Student Name:
Address:
City:
Home Phone:
State: _____________ Zip:
Work Phone:
Mobile #
E-mail
NYU Student ID # N
Current Employer:
Address:
City:
State:
Zip:
Position:
Title:
Department:
Hours/Days:
RN License (list all states):
Emergency contact: Name: __________________________ Phone: _______________ Relationship:
Please discuss any special interests that may be pertinent to your clinical placement;
(Including other languages spoken and if you have a car)
I hereby authorize New York University and the College of Nursing to release all documents relevant to my placement
in a clinical site to appropriate third parties, if necessary. This includes, but is not limited to, my health clearance,
CPR certification, resume, license registration and this completed practicum application form
____________________________________________________
Student Signature
Print Signature
1
Revised 7-2-14
Date
CLINICAL COURSES: HEALTH CLEARANCE & CREDENTIALING REQUIREMENTS
Master’s Program
Clinical Course
NURSE-GN.2012
NURSE-GN.2017
NURSE-GN.2019
NURSE-GN.2023
NURSE-GN.2168
NURSE-GN.2030
NURSE-GN.2032
NURSE-GN.2037
NURSE-GN.2062
NURSE-GN.2063
NURSE-GN.2065
NURSE-GN.2069
NURSE-GN.2097
NURSE-GN.2098
NURSE-GN.2099
NURSE-GN.2117
NURSE-GN.2119
NURSE-GN.2130
NURSE-GN.2132
NURSE-GN.2134
NURSE-GN.2135
NURSE-GN.2133
NURSE-GN.2136
NURSE-GN.2137
NURSE-GN.2138
NURSE-GN.2140
NURSE-GN.2142
NURSE-GN.2173
NURSE-GN.2175
NURSE-GN.2177
NURSE-GN.2187
NURSE-GN.2188
NURSE-GN.2179
NURSE-GN.2180
NURSE-GN.2181
NURSE-GN.2183
NURSE-GN.2185
NURSE-GN.2186
NURSE-GN.2232
NURSE-GN.2233
NURSE-GN.2234
NURSE-GN.2235
NURSE-GN.2143
NURSE-GN.2144
NURSE-GN.2145
Advanced Physical Assessment Across the Lifespan
Adult-Gerontology Primary Care: Practicum II
Adult-Gerontology Primary Care: Practicum III
Nursing Administration Practicum: II
Nursing Administration Practicum: III
Geriatric Syndromes
Health Promotion for Infancy, Childhood & Adolescence
Common Health Problems of Adults and Older Adults & Seminar
Pediatric Primary Care: Practicum I
Pediatric Primary Care: Practicum II
Pediatric Primary Care: Practicum III
Substance Abusing Client Practicum II
Intro to Palliative Care
Symptom Mgt in Palliative Care
Advanced Palliative Care Practicum
Adult-Gerontology Acute Care: Practicum II
Adult-Gerontology Acute Care: Practicum III
Midwifery Mgmt: Practicum I
Midwifery Mgmt: Practicum II
Midwifery Mgmt: Practicum III
Midwifery Mgmt: Practicum IV
Primary Care of Women
MH I: Individual Psychotherapy Across the Lifespan
MH II: Foundations of Psychiatric APN Across the Lifespan
MH III: Group, Couple and Family Psychotherapy Across the Lifespan
MH IV: Child & Adolescent Psychiatric APN Practicum and Supervision
MH V: Adult and Geriatric Psychiatric APN Practicum and Supervision
Nursing Education: Practicum II
Nursing Education: Practicum III
Primary Care of the Older Adult with Multiple Chronic Conditions
Clinical Intensive in Interprofessional Care of Older Adults
Primary Care of the Frail Older Adult with Multiple Chronic Conditions
Introduction to Primary Care
Primary Care of Families: Child & Adolescent Health
Primary Care of Families: Women’s Health
Primary Care of Families: Adult & Geriatric Health Practicum
Primary Care of Families Across the Lifespan Practicum
Nursing Strategies: Health Promotion Across the Lifespan
Assessment and Analysis of Clinical & Nursing Information Systems
Database Design and Decision Support on Clinical &Nursing Systems
Implementation, Management and Evaluation of Clinical & Nursing Systems
Nursing Informatics Integration
Advanced Holistic Nursing: Foundations
Advanced Holistic Nursing: Strategies for Health Coaching and Behavior Change
Advanced Holistic Nursing: Healing with Complementary & Alternative Modalities
2
Revised 7-2-14

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