Psychiatric Nurse Practitioner and Physician Assistant

Clinic Training Program

ONLINE APPLICATION

Start My Wellness offers one-semester clinical training opportunities for individuals enrolled in a psychiatric nurse practitioner or physician assistant education program. To initiate the application process, please provide the following information.

Please note: If you wish to participate in additional semesters, you will need to reapply for each subsequent semester.

"(Required)" indicates required fields

Contact Information

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Email(Required)

Phone(Required)

Program Information

School Attended(Required)

Desired start date for clinical training (Month/Year)(Required)

Learning Objectives:(Required)

Completed Clinical Rotations (include setting and objectives):(Required)

Total Training Hours Sought at Start My Wellness:(Required)

Weekly Hours Available to Commit:(Required)

Preferred Model of Training:

In-Person

Virtual

Hybrid

No Preference

Upload Resume / CV(Required)

Please include a recent resume with this application which identifies all past degrees and certifications, schools attended, and prior work experiences.

Max. file size: 2 GB.

Spam Check - What is 11+5?(Required)