DIVISION OF PHYSICAL THERAPY DEPARTMENT OF ALLIED HEALTH SCIENCES, SCHOOL OF MEDICINE THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL PROGRAM IN PHYSICAL THERAPY Clinical Affiliation Times Available in 2010 Name of Facility _______ ___________________________________________________________________ Address _________________________________________________________________________________ Clinical Education Coordinator _______ _____________________ Phone (____)_______________________ Fax ( )_____________________ E Mail _____________________________________________________ 2nd YEAR DPT STUDENTS *Indicate the # of students and the specialty area/location for each experience offered. PHYT 764 Clinical Practicum II March 1 - April 23, 2010 (8 weeks) Neuromuscular Musculoskeletal Acute Care PHYT 768 Clinical Practicum III April 26 – June 18, 2010 (8 weeks) Neuromuscular Musculoskeletal Acute Care PHYT 764/768 System Rotation March 1 – June 18, 2010 (16 weeks) Please list type of setting(s) for the “system” of care rotation: Neuromuscular Musculoskeletal Acute Care 3rd YEAR DPT STUDENTS PHYT 768 Clinical Practicum III May 10 – July 30, 2010 (12 weeks) Neuromuscular Musculoskeletal Acute Care 1st YEAR DPT STUDENTS PHYT 761 Clinical Practicum I June 21 – August 13, 2010 (8 weeks) Musculoskeletal Acute Care Would you consider 2:1 student to clinical instructor ratio for any of these slots?________ _________________________________________________________________________________________ Comments: Please indicate clearly if any of these slots are first come, first served. Otherwise, we will assume you are holding the listed slots for our students only! __________________________________________________________________________________________ __________________________________________________________________________________________ The deadline to return this form is April 15, 2009. We will call you in August with preliminary assignments. Please return to: Lisa Johnston PT, MS, DPT, UNC-Chapel Hill, Division of Physical Therapy CB# 7135, Bondurant Hall Suite 3000, South Columbia Street, Chapel Hill NC 27599-7135, PHONE (919)843-5723 FAX (919)966-3678, EMAIL ADDRESS: firstname.lastname@example.org A return envelope is enclosed if you would prefer to mail in your form.