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  6. Student Intake Form

Student Intake Form for AHN Clinical Rotation

Thank you for your interest in completing a clinical rotation with AHN. This form is for students seeking a rotation that is an educational requirement. Please complete the following form in its entirety to move through the student onboarding process.

This form is not for shadowing experiences or undergraduate nursing students – for those programs please visit www.ahn.org for more info.

At AHN, the process starts here, not in myclinicalexchange.com. If you’ve already entered info into myclinicalexchange.com, we will deny that rotation and direct you back here.

Timing: Rotations are reviewed 60 to 90 days in advance. If you are requesting a rotation further out that 90 days, that is too early. Please wait to submit this form closer to when you need the rotation.

Student Intake Form

Your information
Additional information

Have you gone by any other names in the past?

Any other email addresses you may have used to complete a rotation with AHN before.

About clinical rotation

Please provide the specialty you need for this rotation

Start date of rotation

End date of rotation

Have you completed a clinical rotation with Allegheny Health Network before?

Not quite. Try again.
  • Yes
  • No

Have you already worked to identify a Preceptor?

Not quite. Try again.
  • Yes
  • No

If yes, please provide their name and email address (Respond with NA if you answered no).

About your school

What program are you currently in at your school that required this rotation?

Is your school’s coordinator aware you are requesting this rotation?

Not quite. Try again.
  • Yes
  • No

If yes, please provide their name and contact information (respond with NA if you answered no).