Application for National University PMHNP & FNP Students (Free Rotations)

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Do you have WhatsApp?

Once trainees sign up we make a group chat on WhatsApp so that our team members can work with you most directly and efficiently

Yes

I can download it

I prefer to avoid using WhatsApp if possible

Gender

Female

Male

Other

Specialty Track of Student

PMHNP

FNP

Other

Select your class

(National U) PMHNP MNP 694C (240 hrs) (Adults & Aging)

(National U) PMHNP MNP 687C (180 hrs) (Children & Adolescents)

(National U) PMHNP MNP 688C (120 hrs) (Psychotherapy)

(National U) FNP 683C (180 hrs) (Primary Care of Adult and Aged)

(National U) FNP 684C (180 hrs) (Women and Children)

(National U) FNP 685C (240 hrs) (Residency Practicum)

MD or NP preference

Do you prefer an MD or NP as preceptor?

Medical Doctor

Nurse Practitioner

Therapist

No preference

Preceptor Specialty

Choose the specialty of the preceptor that you need

Internal Medicine

Family Medicine

Pediatrics

OB/GYN (Women's Health)

Psychiatry

Individual Therapy

Group Therapy

Other

I'm not sure

Start Date for Rotation

When will your rotation begin?

MM

DD

YYYY

Location

Where are you located?

Washington DC / Baltimore / Northern VA metropolitan area

Los Angeles / Southern CA

Chicago

Houston

New York / New Jersey

Other

I am open to doing part or all of my rotation as a tele-medicine experience during Covid-19

Many Universities are allowing 100% tele-medicine during Covid

Yes

No, I want to avoid tele-medicine learning

I have not decided but I am open to the possibility