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Forms for Students

This information applies to students formally enrolled in a professional program and have a current contract with Cone Health*.

*Alamance Regional students should contact Mike Sherk for any necessary forms and information.

At least two weeks prior to your affiliation, you and/or your program must provide us with various pieces of information contained below. Some information may be faxed, mailed or e-mailed to the Center Coordinator of Clinical Education (CCCE). Please include the completed checklist in your packet.

If you have not received a confirmation e-mail with necessary pre-affiliation information at least three weeks prior to your affiliation, please contact us so that we may provide you with the name of your CI and the site and venue to which you have been assigned. On the morning of your first day, you will report to a pre-designated time and place as outlined in your confirmation e-mail.

Therapeutic Recreation students should contact Rebecca Medendorp for inquiries regarding observations, interviews, internships or practicums at our facilities.

Required Paperwork

Contact Us

For All Specialities (all campuses except Alamance Regional)

Rebecca Medendorp Boone, PT, DPT, CCCE
Email Rebecca

For All Specialties (Alamance Regional only)

Mike Sherk, PT, CCCE
Email Mike

Observation Contacts

  • Acute and inpatient rehab observations: 
    Email Us.
  • Outpatient rehab observations: 
    Email Us