Student Application For Therapy Clinical Rotations

Company

This field is for validation purposes and should be left unchanged.

First Name(Required)

Middle Initial(Required)

Last Name(Required)

Email(Required)

Phone Number(Required)

School Information

Please provide your school affiliation.(Required)

Please provide the name and email address of a contact from your school.(Required)

Location Preference

Madonna Rehabilitation Hospitals offers clinical experiences in outpatient neurological, outpatient orthopedics, outpatient pediatric, inpatient adult, and inpatient pediatrics (Omaha only).

Please indicate your first choice for clinical rotation location(Required)

Lincoln

Omaha

Are you willing to be placed in either location?(Required)

Yes

Discipline

Please indicate the discipline for which you are applying.(Required)

Physical Therapy

Occupational Therapy

Speech Therapy

Recreation Therapy (Lincoln Only)

Please indicate your first choice for clinical experience.(Required)

Please indicate the type of clinical rotation you're interested in.(Required)

Level 2

Capstone

What is the focus of your capstone?(Required)

Please indicate the type of position you are interested in.(Required)

PTA

Are you interested in an inpatient or outpatient speech therapy position?(Required)

Inpatient

Outpatient

Please indicate the type of position you are interested in.(Required)

OTA

Please indicate the length of internship(Required)

8-weeks

10-weeks

12-weeks

14-weeks

Please rank your preference for clinical experience.

Rank the options from highest to lowest preference where 1 is highest and 4 is lowest.

Inpatient Adult(Required)

Please enter a number from 1 to 4.

Outpatient Adult(Required)

Please enter a number from 1 to 4.

Inpatient Pediatric(Required)

Please enter a number from 1 to 4.

Outpatient Pediatric(Required)

Please enter a number from 1 to 4.

Please select area(s) of interest:(Required)

Select all that apply.

Would you prefer to interview in-person or online?(Required)

In-Person

Online

What is your preferred start date?(Required)

Are you interested in a wheelchair seating/positioning hybrid experience?(Required)

Yes

Please list the dates for your available clinical experiences for this next year:(Required)

Please attach your resume.(Required)

Max. file size: 1 MB.

Please attach your cover letter.(Required)

Max. file size: 1 MB.

If applicable, please upload a letter of recommendation.(Required)

Max. file size: 1 MB.

CAPTCHA

School Information

Location Preference

Discipline

Please rank your preference for clinical experience.