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Graduate Student
Clinical Internship Application

Once you have completed this application, click submit at bottom. This will forward your application to the Erlanger Clinical Placement Coordinators. Thank you. 


Name:  *Phone:  *School Email: Personal Email Are you a current Erlanger employee? If yes, what department? Have you ever been employed by Erlanger Health System? If yes, when? If yes, what department? 

Academic Institution

Institution Name Program you are enrolled in: Academic Contact Name and Title: Academic Contact Email: Academic Contact Phone: 

Clinical Request

Rotation Type (Specialty): Total hours: Start date: End date: Have you contacted anyone at Erlanger regarding serving as your preceptor? If yes, Potential preceptor name and department: Potential preceptor name and department: Potential preceptor name and department: