Clinical Nurse Practitioner and Physician Assistant Students

Clinical Nurse Practitioner, Physician Assistant or Nurse Anesthetist Student Process

There are six (6) steps listed below. All steps reference documents that must be returned to your Program Clinical Coordinator at least two weeks prior to your intended rotation start date. Incomplete materials will not be accepted which may result in a delayed start date.

Steps To Be Completed

1. Registration Form

Complete the entire form, ensuring a start and end date and the name of the St. Luke’s Hosting Supervisor are listed. Please print and return the registration form to your Program Clinical Coordinator.

2. Criminal History Clearances to be completed, then submit originals to your school program director.

FBI Fingerprinting through the Department of Human Services: Please follow the process detailed in the FBI Clearance Handout to ensure you complete the correct clearance.
Child Abuse Clearance
PA State Criminal History Check
Universal Child Protective Services Law Affirmation Form

Students assigned to Warren Campus are to complete this additional requirement as outlined by the State of New Jersey.
NJ State Police Name Check

Please print and return to your Program Clinical Coordinator.

3. Acknowledgement forms attesting to your willingness to follow hospital policies/procedures (3 forms for completion). Please print and return to your Program Clinical Coordinator

a. Commitment to Privacy

b. Student Statement of Responsibility and Research Acknowledgement (updated 1/14/2020)

c. Student IT Access form 1 of 2

d. Student IT Access Form 2 of 2

4. Health History Screening (2 steps) Please ensure your health history meets the requirements outlined in the Immunization History and Drug Screening Requirements. Students are responsible for costs associated with additional immunizations or testing.

a. Immunization History Form

It is important to note that all students are to have the most current, annual flu shot during flu season. Exemptions (religious or medical) may be submitted to your school program director and will be reviewed by St. Luke’s personnel for review. Your school program director will be notified if the exemption is approved.
For those with questions regarding new flu requirement, please review this FAQ developed by our Employee Health Department.

b. Drug Screen Requirements Form

Your Program Clinical Coordinator can provide you with the names of approved facilities to have the drug screening completed.

c. UPDATED 7/9/2020: Coronavirus Screening Form

Please complete this form and provide to your St. Luke's Hosting Manager within 3 days of starting your St. Luke's assignment
All students are required to take their temperature daily prior to coming to St. Luke's, ensuring it is less than 100.4 degrees Fahrenheit. Those with a temperature above 100.4 should not report for their assignment.
Cloth masks are required to be worn at all times, starting at your car, throughout your scheduled shift and remove when you get back into your car at the end of your day.

5. Network Orientation Signing the Student Statement of Responsibility and Research Acknowledgement form indicates your acceptance of the terms and conditions as outlined below.

Please read both documents as they explain important safety practices and policies every student should be aware of during your internship at St. Luke’s University Health Network.

a. Student Orientation

b. Essentials Newsletter