Nursing Student Registration Form

Welcome to Kindred Nursing Student Programs! We are here to support you as you complete your clinical rotation with resources, made especially for you. Please finish the online registration form which asks you to provide information we will use to stay connected with you throughout your rotation and as you approach graduation. We look forward to having you in our Hospital and hope you enjoy your experience with Kindred Healthcare!

If you have any questions or concerns, please contact your Nursing Student Program Manager Laura Dailey at Laura.Dailey@Kindred.com, 314-659-2116. Thank you!

    Student Name (required)

    Student Email (required)

    Address

    City

    State

    ZIP

    Phone

    Graduation Date (required)

    Name of School

    Degree Program

    If Other

    Faculty Member/Preceptor Name

    Faculty Member/Preceptor Email Address

    Hospital Name

    Practice Setting

    Hospital Location: City/State

    Start Date of Clinical Rotation

    End Date of Clinical Rotation

    Would you like to be paired with a professional nursing mentor?

    yesno

    Additional Comments