St. Mary’s Health Care System Inc, ®
Instructor Contact Form
We thank you for choosing St. Mary’s Health Care System, Inc.® as an instructional site for your
students. Provided below is an overview of the requirements for placing your students at St. Mary’s:
1. Submit placement requests to the Department of Clinical Education.
2. Provide the name and contact information for each instructor at the educational institution that will
be on site at St. Mary’s.
a. The institution will:
i. Provide student and faculty documentation upon request.
ii. Require each student to complete the “Student Orientation Packet” annually
iii. Share pertinent information with your program directors, faculty, and students
regarding St. Mary’s policies and procedures.
iv. Notify us if the contacts change.
3. A curriculum and skills list is requested at the beginning of each new academic year.
4. Students shall wear their school uniform and name badge at all times while on the St. Mary’s campus.
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Institution
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Program
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Date
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Print Name
Title
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Contact information (phone)
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Contact information (e-mail)
Should you have any questions or concerns please do not hesitate to contact the Clinical Education
Department. We look forward to working with you.
St. Mary’s Health Care System, Inc.® ● Clinical Education Department ● 1230 Baxter Street ● Athens, GA 30606
706-389-2150 (P).® ● 706-389-2151 (F) ● clinicaleducation@stmarysathens.org