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Clinical Rotation/Observation Forms Request

You are on this page because you have been directed to this link to request the proper paperwork for Clinical Rotation/Observation. Please complete the form below on the topic that matches your need.

MEDICAL, APRN, AND PA STUDENTS PLEASE NOTE:

For certain clinical areas, the student must be first be approved by the Medical Executive Committee (MEC) prior to starting the clinical experience. Requests submitted after the second Thursday of each month will be held until the following month’s MEC meeting. Please be aware that completing an application does not guarantee placement, as opportunities are limited. Once the application has been received please allow at least 8 weeks for processing.

⚠️ Please Read Before You Begin ⚠️

Does your school have an Education Agreement with Salina Regional Health Center for your program or discipline?

✔️ Please check with your school before starting this application.

If your school is not listed, stop completing the form and contact us at OrgDevStudents@srhc.com or 785-452-7333. We will work directly with your school to set up the agreement.

➡️ Keep in mind: If no agreement is in place, this may delay the start of your clinical experience. To avoid delays, we recommend reaching out at least four months in advance.

Submitting this application does NOT guarantee placement.

You will need to upload the following documentation to complete your application:

✅MMR vaccination record
✅Varicella vaccination record
✅Hepatitis B vaccination record
✅Influenza vaccination record (must be from the current flu season: October 1–March 31 )
✅TB test results (must be within the last 12 months, e.g., 12/1–12/1)
✅Personal Photo ID or School ID

❗Important: Your progress will Not be saved. If you exit before finishing, you will have to restart the application.

Begin Application

To look up office phone numbers to contact physicians with requests, please use our Physician Directory found here.

For questions on completing the above paperwork, please contact:

Organizational Development
Salina Regional Health Center
Phone: (785) 452-7333
Fax: (785) 452-7327
E-mail: orgdevstudents@srhc.com