ALL STUDENTS ASSIGNED TO MERCY HOSPITAL AND MERCY PROS MUST download, read, and complete all the forms in the section marked “A” Forms.

Once completed, ONLY 4290 COURSES, email the following forms directly to DTrotman@molloy.edu.

All other courses must email the forms directly to their clinical instructors.

1. Workplace Violence Post Test
2. Confidentiality Statement
3. Employee Screening Attestation (must send all the 3 in one email)

ALL NUR 4290 BEHAVIORAL Health Students Must, also in addition to “A” forms, download, read, and complete the forms in section marked “B” Forms. Once completed, email the following forms directly to DTrotman@molloy.edu.

1. Student Contact Sheet
2. Code of Conduct (last page only)
3. Mandating Reporting (last page only)
4. SCR-include all addresses from birth to present (there are additional pages if needed)
5. Policies, Procedures & Signature READ, (90 PAGES) SIGN last page
6. Information Acceptable Use Policy Agreement READ (Sign last page)
7. Acknowledgment of Policies & Procedures READ (Sign last page)
8. Compliance Program Handbook READ (Sign last page)

ONLY NUR 4290 STUDENTS ASSIGNED TO MERCY PROS, MUST also download and complete the section marked “C” Forms. These are the fingerprint application forms and the criminal background check form. These must be returned to DTrotman@molloy.edu. Once they are submitted to Mercy, Fatima Shamulzai will coordinate your appointment based on the availability you have chosen.