Rehabilitation Clinical Placement forms

Forms and verification of requirements

Students must have the following forms completed for the clinical experience:

Affiliation Verification form - confirms that all requirements regarding criminal background check, vaccinations and Basic Life Support (BLS) have been met. Please see your school's Coordinator/Director of Clinical Education (DCE), Fieldwork Coordinator, or contact the Aurora Rehab Services Student Coordinator for details of specific requirements. This form must be completed and returned by the DCE/Fieldwork Coordinator to the Aurora Rehab Services Student Coordinator no later than 2 weeks before the start of the clinical experience. The form will not be accepted if submitted by the student.
Student Emergency Contact Information [PDF] – Students’ emergency contact information will be kept with the department staff phone list. Please complete this form and turn it in to your Clinical Instructor on your first day of the clinical experience.

After completing your rotation, you are encouraged to submit feedback about your clinical instructor and the site or sites at which you trained.

Please print, complete and submit to your site coordinator at the end of the clinical experience: