Clinical Coordinator Status Appointment Application

  • In accordance with the process for Status Appointment applications, please fill in and submit the information below. The Office for Clinical Education will review your application and forward you confirmation by mail. If you have any questions, please e-mail or call (416) 596 3101 ext. 3328
  • Part I - Clinical Coordinator Information

  • Part II - Registrar Information

    The following information will only be used by the Registrar’s Office for registration purposes and consolidation of duplicate records.
  • Part III - Acknowledgement

  • I recognize and agree to fulfill the responsibilities required by the status-only appointment as Clinical Coordinator:
    • Administration and coordination of the student’s clinical education
    • Liaison with Michener for the placement of clinical students
    • Direct communication link between the clinical site at the department level and the Clinical Education Office and program Clinical Liaison Officer at Michener
    • Overall supervision of the education and evaluation of clinical student(s)
    • Direct accountability for the clinical student’s overall attainment of all clinical competencies
    • Annual identification of staff members assigned to be clinical educators
  • MM slash DD slash YYYY
  • Please also provide your Manager/Supervisor’s information below to validate support for this application.