Nursing Students for Sexual and Reproductive Health: Clinical Externship Application Form
This form will take approximately 15 minutes to complete.

NSSRH's Clinical Externship Program is a unique opportunity to be placed directly in a clinical site that provides full scope family planning services, including abortion. This is a privileged program, that relies on the good will of clinical host sites as well as the professional and ethical behavior of CEP participants.

By applying for this program, you are committing to completing your clinical rotation at the agreed upon location, regardless of other circumstances (like graduation or school schedule). Training spots in clinical host sites are extremely limited and competitive, and it is through the generosity of the clinic administration and staff that we are able to secure training spots, which often go to MD and DO students before nursing students.

Certain states have significantly reduced access to clinical host sites, for a variety of reasons, and NSSRH is not able to guarantee that a site will be available, and TRAVEL may be required (this will be discussed in more detail during your interview).

Time from completion of your application to placement in clinic varies, due to a variety of factors, with an average time interval of 4 months. Timely completion of your background check and other application documents will expedite your placement.

If you think that for any reason you might be unable to complete your externship, please consider applying at a later date. Please contact clinical@nssrh.org if you would like to discuss your circumstances in more detail with a program manager.

You must be a member of an active NSSRH chapter in order to apply for this program. Don't have a chapter at your school? Start one today! Email clinical@nssrh.org to find out how, or visit our website for more information.

Name: *
Age: *does not affect your ability to participate in program* *
School email address: *
Non-institutional email address (personal email address is REQUIRED): *
Mailing address (we will be mailing you materials related to CEP, please provide FULL address, including street number, apt #, city, state, and zip code): *
Will your mailing address change or become inactive in the next calendar year? *
If you answered YES or MAYBE, please provide us with a permanent back up address: *
Phone number: *
Please indicate if this is a cell phone, and if it is ok to text you at this number: *
Gender Identity: *
Required
Ethnic and Racial Identity: *
Required
School that you are currently enrolled in: *
Name of NSSRH chapter and name of chapter leader:
Name and location (city/state or zip code)of facility where you would like to be placed (enter none if you are unsure): * note, NSSRH does NOT guarantee placement at a particular facility, however we will do our best to accommodate your wishes. You are required to take the clinical spot that is made available to you if it is within a two hour (120 mile) radius of you* *
Year (ie: 1st yr), expected graduation date: *
Degree path: *
Required
Please list any sub-specialty that you are being credentialed in (ie: pediatrics): *
Is there any particular population that you plan on working with after graduation (ie: unhoused folks, inmates, children and adolescents, LGBTQI+/trans folks, etc)...? *
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