Affiliate Agreement Inquiry

* fields are required

Thank you for your interest in becoming a clinical affiliate for our Nursing and Health Professions programs. We are excited that you are seeking information and are interested in providing an opportunity for students interested in healthcare professions to gain clinical/practicum experience at your location.

Please provide the following information and someone from our department will reach out to you for further information:

Name of the Organization/Hospital: *

Primary Contact Name: *

Primary Contact Position: *

Primary Contact Email Address: *

Primary Contact Phone Number: *

Corporate/Business Location Address: *

Number of students per semester: *

Semester you would like to begin hosting: *

Anything else about your site you would like us to know:

Thank you for helping to support the mission of Cuyahoga Community College:

To provide high quality, accessible and affordable educational opportunities and services — including university transfer, technical and lifelong learning programs —that promote individual development and improve the overall quality of life in a multicultural community.

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