Carroll Community College

Nursing Program
Nursing Student Practicum Schedule

Directions: Student to complete this form with preceptor during the first week of practicum, then email a copy of form
to faculty triad partner no later than the end of the first week. Remember: Total hours required = 125 (include your
orientation). If any changes in the schedule occurs during the preceptorship, a revised copy of this form needs to be
submitted to the faculty triad partner.

Britney Pintha Morgan Shade (410)259-4561

Print student name Print preceptor name and phone number

Carroll Hospital IMC (410)871-7073

Name of facility/hospital Name of specific unit Unit phone number

Scheduled Day Hours scheduled Number of hrs. Additional Information

mm/dd/yy (e.g., 0630-1830) (e.g., 12 hrs.)
04/07/22 1500-1600 1 orientation

04/11/22 0630-1900 12 hrs. 30 min.

04/12/22 0630-1900 12 hrs. 30 min.

04/14/22 0630-1930 13 hrs.

04/19/22 0630-1900 12 hrs. 30 min.

04/25/22 1830-0700 12 hrs. 30 min.

04/27/22 1830-0700 12 hrs. 30 min.

05/01/22 0630-1900 12 hrs. 30 min.

05/06/22 1830-0700 12 hrs. 30 min.

05/07/22 1830-0700 12 hrs. 30 min.

05/08/22 1830-0700 12 hrs. 30 min

Additional schedule information may be added on reverse side.

TOTAL HOURS: 126 hrs. 30 min

1/2022
 Carroll Community College
Nursing Program
Nursing Student Practicum Schedule

Scheduled Day Hours scheduled Number of hrs. Additional Information

mm/dd/yy (e.g., 0630-1830) (e.g., 12 hrs.)

TOTAL HOURS:
1/2022