Non-Clinical Agreement Request Form

This form to be completed by the faculty member who wishes to precept a non-UVA student (for example: precepting a nurse educator student from another Virginia college/university).

Please note: non-clinical agreements are for non-UVA students completing hours in the School of Nursing and do not apply to experiences in any other environment including the UVA Medical Center. If a student wishes to complete practicum hours in both the UVA School of Nursing and the UVA Medical Center, they will also need to seek an agreement with the Medical Center; the student's college/university contracts coordinator should contact the UVA Medical Center directly.

Steps: Faculty member and external student discuss the preceptorship. Faculty member submits this non-clinical contract request form or informs the student that their school's contracts coordinator should contact the SON Contracts Coordinator (Devonia Love). The request is routed to the Associate Dean for Academics for approval. Once approved, the SON Contracts Coordinator informs the faculty member and initiates agreement with the student's school. Once both parties agree and execute the agreement, the SON Contracts Coordinator sends a finalized copy to the student's school and the faculty member.