Clinical Faculty Academy

Make A Difference in St. Louis Health Care

The Clinical Faculty Academy is a two-day conference designed to help prepare registered nurses for their important roles as clinical instructors in area nursing programs. The Academy was created through a collaborative effort between nursing schools and hospitals in the St. Louis metropolitan area. There is no fee to participate in the Academy.

If you have already registered and would like to cancel your registration click here.

Please complete the following form to register for the Clinical Faculty Academy.

* required fields

First Name*	Last Name*
Title/Work Role/Department
Hospital	--Please Select-- All Saints Special Care Hospital Alton Memorial Hospital Anderson Hospital Barnes-Jewish Hospital Barnes-Jewish St. Peters Hospital Barnes-Jewish West County Hospital CenterPointe Hospital Christian Hospital Crossroads Regional Medical Center Des Peres Hospital Forest Park Hospital Jefferson Memorial Hospital Kenneth Hall Regional Hospital Kindred Hospital-St. Anthony's Kindred Hospital-St. Louis Memorial Hospital - Belleville Missouri Baptist Hospital-Sullivan Missouri Baptist Medical Center Ranken Jordan Hospital Rehab Institute of St. Louis Saint Anthony's Health Center Saint Louis University Hospital Shriners Hospital for Children SSM Cardinal Glennon Child Hospital SSM DePaul Health Center SSM Rehab SSM St. Joseph Health Center SSM St. Joseph Hospital of Kirkwood SSM St. Joseph Hospital West SSM St. Mary's Health Center St. Anthony's Medical Center St. Elizabeth's Hospital St. John's Mercy Hospital St. John's Mercy Medical Center St. Joseph's Hospital - Breese St. Louis Children's Hospital Touchette Regional Hospital
School	--Please Select-- Barnes-Jewish College of Nursing Chamberlain College of Nursing East Central College Jefferson College Kaskaskia College Lewis and Clark Community College Lutheran School of Nursing Maryville University McKendree College Sanford Brown College Southwestern Illinois College St. Charles Community College St. Louis Community College at Florissant Valley St. Louis Community College at Forest Park St. Louis Community College at Meramec St. Louis University School of Nursing University of Missouri - St. Louis College of Nursing Webster University
Work Phone	Home Phone
Cell Phone	Pager
E-mail*
Home Address*
City*	State*  AA AE Alabama Alaska Alberta, Canada AP Arizona Arkansas British Columbia, Canada California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam, US Territory Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba, Canada Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick, Canada New Hampshire New Jersey New Mexico New York Newfoundland, Canada North Carolina North Dakota Northwest Territories, Canada Nova Scotia, Canada Nunavut, Canada Ohio Oklahoma Ontario, Canada Oregon Pennsylvania Prince Edward Island, Canada Puerto Rico, US Territory Quebec, Canada Rhode Island Saskatchewan, Canada South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands, US Territory Virginia Washington West Virginia Wisconsin Wyoming Yukon Territories, Canada ZIP*
Highest Degree Earned* BSNMSNOther
Expected Graduation Year for MSN
Have you worked as a clinical educator?* Noless than 1 year1-5 years5+ years
Age Category* 20-2930-3940-4950 and older
Date Attending Clinical Faculty Academy* Clinical Faculty Academy
If you have special requests, including physical or dietary accommodations, please list them in the following box.

A list of participants and their contact information, including cell and work phone and e-mail address, will be distributed to participants. If you do not want to share this information, please check the corresponding box.

No, I do not want to share my cell phone with participants.

No, I do not want to share my work phone with participants.

No, I do not want to share my email address with participants.