Instructions for Nursing Students:

The Wm. Jennings Bryan Dorn VA Medical Center has 65 Educational Affiliation Agreements with 47 educational institutions supporting 19 disciplines. In FY06, approximately 400 students participated in affiliated education programs such as Audiology and Speech Pathology, Chaplain Services, Dental Auxiliaries, Dietetics, Imaging, Laboratory, Nursing, Optometry, Pharmacy, Rehabilitation, and Social Work.

All nursing students assigned to the William Jennings Bryan Dorn VA Medical Center (Dorn VAMC) must read and review the following documents and print and complete the following required forms. All forms must be turned in to Education (or to your instructor if assigned) at least two weeks before the scheduled training date.

If you have any questions regarding these instructions, please contact Education Service Line at (803) 776-4000 extension 4193.

You will need the Adobe Acrobat Reader to open the forms on this page. Get it here: 

In order to facilitate in processing at the Dorn VAMC, we request that you complete the required paperwork and mandatory training prior to your arrival.  Please follow the instructions below:

Make sure you have a printer available.  Some of these forms can not be saved.

Please complete and print the following forms.  Make sure to sign and date where necessary:

•     Application - Optional Form 612

•     Educational Institution Verification Letter (Sample) - A letter must be provided by your school verifying your enrollment status, rotation dates, health status, and proof of tuberculosis test within 1 year. Students providing direct patient care must also verify current AHA or ARC CPR certification. (One letter can suffice for all students and may be provided by the instructor.) Download the Educational Institution Verification Letter.

•     Registration Form

•     Fingerprint Submission Form

•     Request for Personal Identity Verification Card VA Form 0711, SECTION I - APPLICANT INFORMATION Items 1 - 9. NOTE: To receive an ID Card you must present two forms of identification as listed on page 5.

•     Computer Access Agreement

•     Local Area Network User Agreement

•     Computer Access Application

  • Access Needed - use this form if computer access IS needed

  • No access needed  - use this form only if computer access IS NOT needed

•     Trainee Statement of Commitment

•     Certification of Orientation and Training

•     Nursing Student Orientation Test (Orientation booklet below)

The following training must be completed by all personnel (read on-line if possible):

•     VHA Privacy Policy and Cyber Security Awareness courses
  https://www.vcampus.com/vcekpvalo/servlet/ekp/login/  Be sure to print certificates – you will need to turn them in to receive credit for this training.

•     Student Nurse Orientation Book

Questions? Contact Renee M. Woerner at extension 803-695-7934

US Department of Education | JCAHO  

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