MP Register Student

Register Your Student

Be sure and consult the calendar for when Spring and Summer 2025 students may be submitted!

We recommend that you check the clinical requirements for the facility BEFORE registering the student to minimize surprises and potential delays!

Managed Partner Student Submission Form

This form is used for a TCPS Managed Partner's clinical placement coordinator or other school representatives to submit a student for a precepted clinical placement. Required Fields are noted! We recommend that you check the clinical requirements for the facility BEFORE registering the student to minimize surprises and potential delays! Use the TAB key to quickly move between fields!

Today's Date(Required)

MM slash DD slash YYYY

YOUR Name(Required)

Enter YOUR Name as the school's primary contact for the student's clinical placement.

First Last

Your School Name(Required)

Your Program of Study(Required)

I have placed students in the past using TCPS.(Required)

Your Email(Required)

Your Phone Number:(Required)

Phone Type:(Required)

Payment Status(Required)

Select the payment status for your school. This is critical to our providing your student with access to the correct payment portal.

Student pays the per student fee! ($50 and $25 for subsequent placements this academic year). The School pays the annual partnership fee to TCPS.

School will pay the per student fee(s) by credit card - send payment information to me!

Student pays the related school partnership fee AND the student fee! ($150/student) + $25 for any additional placements this academic year.

Other payment option - enter details below

Enter details of other Payment Option that has been previously approved:

Student Information

STUDENT's Name(Required)

Enter the name of your student here!

First Last

Has this student been placed before using TCPS Onboarding?(Required)

Yes, earlier THIS academic year

Yes, in a PREVIOUS academic year

Unknown

Has this student had the COVID vaccine?(Required)

This question is required by some facilities prior to the placement approval process. Other facilities will require the student to have the vaccine as part of the student approval process.

Yes

Unknown

Placement Information

Facility or Health System where this student will be going for this placement:(Required)

Patient Care Unit, Department, Clinic, Physician Practice, etc.:(Required)

Enter the location where the student will be placed. This can be a patient care unit, facility department, outpatient clinic, or a physician practice as appropriate for the student.

Is this student an EMPLOYEE at the facility/health system for this placement?(Required)

Yes

Unknown

Name of the Facility Individual that APPROVED this placement:(Required)

This may be the Preceptor, a Manager, or another individual at the facility that approves precepted students. IF this placement has not been pre-approved, enter UNKNOWN for the first and last name. Pre-Approval is frequently required for advanced practice placements for Nurse Practitioners, Physician Assistants, and Interns! If in doubt, check with your facility contact.

First Last

PRECEPTOR's Name:(Required)

Enter the Preceptor's name. IF the Preceptor is unknown at this time, Enter UNKNOWN for the first and last name.

First Last

Do you have a signed preceptor agreement with the preceptor?(Required)

This is required by some facilities as noted in your clinical affiliation agreement.

Yes

Not applicable for this facility or my program of study

Proposed Student Placement START Date: (This should be the actual start date, not the first day of a clincal term!(Required)

MM slash DD slash YYYY

The Proposed Start Date is:(Required)

Greater than or within 3-4 weeks from today

2-3 weeks from today and student has all clinical requirements other than orientation-related

< 2 weeks from today - EMERGENT Placement!

Proposed Student Placement END Date:(Required)

MM slash DD slash YYYY

What is the Schedule for the Placement?(Required)

Use these selections to identify the days of the week the student will be in the facility.

Student follows preceptor's schedule

Monday thru Friday

Specific Day: Monday

Specific Day: Tuesday

Specific Day: Wednesday

Specific Day: Thursday

Specific Day: Friday

Specific Day: Saturday

Specific Day: Sunday

What are the Total Required Clinical Hours for this placement?(Required)

Are there other aspects of this placement that you need to share?

Does this student have a second placement THIS TERM at a TCPS facility?

Yes

2ND Placement Information for THIS TERM! (Do NOT enter placements for subsequent terms!

Facility or Health System where this student will be going for this SECOND placement:(Required)

Patient Care Unit, Department, Clinic, Physician Practice, etc. for this SECOND placement:(Required)

Enter the location where the student will be placed. This can be a patient care unit, facility department, outpatient clinic, or a physician practice as appropriate for the student.

Is this student an EMPLOYEE at the facility/health system for this this SECOND placement?(Required)

Yes

Unknown

Name of the Facility Individual that APPROVED this this SECOND placement:(Required)

First Last

PRECEPTOR's Name for this SECOND placement:(Required)

Enter the Preceptor's name. IF the Preceptor is unknown at this time, Enter UNKNOWN for the first and last name.

First Last

Do you have a signed preceptor agreement with the preceptor for this this SECOND placement?(Required)

This is required by some facilities as noted in your clinical affiliation agreement.

Yes

Not applicable

Proposed SECOND Placement START Date:(Required)

MM slash DD slash YYYY

The Proposed Start Date for the SECOND placement is:(Required)

Greater than or within 3-4 weeks from today

2-3 weeks from today and student has all clinical requirements other than orientation-related

< 2 weeks from today - EMERGENT Placement!

Proposed SECOND Placement END Date:(Required)

MM slash DD slash YYYY

What is the Schedule for the this SECOND Placement?(Required)

Use these selections to identify the days of the week the student will be in the facility.

Student follows preceptor's schedule

Monday thru Friday

Specific Day: Monday

Specific Day: Tuesday

Specific Day: Wednesday

Specific Day: Thursday

Specific Day: Friday

Specific Day: Saturday

Specific Day: Sunday

What are the Total Required Clinical Hours for this this SECOND placement?(Required)

Are there other aspects of this this SECOND placement that you need to share?

Ready to Submit

CAPTCHA

Register Your Student

Managed Partner Student Submission Form

Student Information

Placement Information

2ND Placement Information for THIS TERM! (Do NOT enter placements for subsequent terms!

Ready to Submit

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