Clinical Rotation Faculty Registration

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Placement Registration Form

Thank You for placing your student with Kindred Healthcare. In the following sections you will be reviewing required compliance documents and attesting your student meets all requirements to complete their clinical in our facilities. All sections must be completed in full before you can submit your registration. If you have questions, contact Meeya Hill at Meeya.Hill@kindred.com.

STUDENT INFORMATION

Student First Name Student Middle Name Student Last Name Student Email Discipline

HOSPITAL INFORMATION