NAU's Green Form: what it asks, who files it and when
The FNP Preceptor/Agency Green Form is how a Northern Arizona University FNP student hands NAU a preceptorship, either one already arranged or one the student wants NAU to request. You complete it yourself and tick one of two boxes, and on the 2022-23 version it is due by March 31 for summer, June 30 for fall and October 31 for spring.
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What the form is for
The Green Form is Appendix F of NAU's 2022-23 FNP Clinical Guidelines, headed the Preceptor/Clinical Site Request Form and last revised in March 2021. It answers its own opening question: its purpose is "To involve the Clinical Placement Coordinator in order to secure a preceptorship you've already arranged or request one you are interested in."
Think of it as the document that turns a conversation with a preceptor into a request NAU can act on. The guidelines' procedure starts with it: once a student identifies a potential preceptor or mentor, completing the form is step one, ahead of the agreement check, the credential review and the approval.
Students on older plans may remember it from the 2021-22 guidelines, where the form (revised in 2019) was to be sent after a preceptor had accepted the student, or when the student wanted help securing a specific rotation. A member of the clinical coordination team then helped obtain the placement or confirmed it with the proposed site.
Who fills it in, where to find it, where it goes
The student completes it. The form says so in as many words, and the 2021-22 version added a warning: "Do not send it to your proposed site to complete." Your preceptor supplies credentials separately; the form itself belongs to you.
The guidelines name three places to get it: the course content for NUR 661, NUR 663 and NUR 665, the Clinical Placement Coordinator, or the FNP Program Coordinator. Completed forms go to the FNP clinical coordination mailbox printed on the form, so use the address on the copy in your current course rather than one saved from an earlier semester.
PMHNP students have no readable handbook to consult. Search-engine text from the removed 2023-24 APRN handbook suggests the same form came from the Clinical Placement Coordinator or the student's program coordinator, but that text cannot be verified, so ask your program coordinator which request form your track uses.
The two boxes, and what each tells NAU
Under "Assistance Needed," the form offers two choices, and picking the right one shapes everything that follows.
- The clinical site approved this placement. You have already arranged it. The site has agreed to host you, so the Clinical Placement Coordinator's task is to confirm the rotation, check for an agreement and move it toward approval.
- Need assistance requesting this placement. You know where you want to go, but the site has not said yes, or it takes requests only from schools. The coordinator makes the approach on your behalf.
The first box is the quicker route, because the hardest part, a site willing to host, is already done. The second box suits large health systems that publish a school-only request route, such as those in our Arizona health systems guide. Either way, the FNP Program Coordinator still approves the preceptor.
What to have ready before you fill it in
The archived forms show the kind of detail NAU wants, though the copy in your course shell is the version to follow. The 2021-22 form asked for the preceptor's credential, with MD, DO, FNP and Other as the options, and for an administrative contact at the site. Pull these together first:
- The details that identify your preceptor, their credential and the practice location
- The site's administrative contact: the person who will receive the affiliation agreement and confirm the rotation, often the office manager rather than the preceptor
- The practicum course and the term you are requesting
- Which box applies, with written confirmation if the site has already agreed
- The preceptor's CV or resume, license and any specialty certification, which NAU asks the preceptor to provide
Deadlines: the two versions disagree
NAU's two archived versions of the form set different cutoffs. The 2022-23 form warns that requests arriving after its dates "may not be completed in time for the beginning of the target semester." The 2021-22 form asked for requests a month sooner.
| Target term | FNP practicum | 2022-23 form | 2021-22 form |
|---|---|---|---|
| Summer | NUR 661 | March 31 | Before March 1 |
| Fall | NUR 663 | June 30 | Before June 1 |
| Spring | NUR 665 | October 31 | Before October 1 |
No newer form is public, so ask the Clinical Placement Coordinator which dates apply to your cohort, and aim for the earlier set if you cannot confirm. A separate rule wants clinical documents on file two months before rotations; for a summer start that can land before March 31. The clinical documents deadline guide covers it.
A missed cutoff is a risk, not an automatic refusal: late requests may not be finished in time, so contact the Clinical Placement Coordinator the day you know you will be late.
After you submit
The form sets the rest of the procedure moving. If NAU has no affiliation agreement with the agency, one is started from the information you gave, and the 2021-22 form cautioned that this can take anywhere from days to months. The preceptor then sends credentials, the FNP Program Coordinator reviews and approves, and NAU lets you know when you may start.
Keep a copy of every form you send and note the date you sent it. If a week or two passes without word, a polite status question to the Clinical Placement Coordinator is reasonable. Our affiliation agreements guide explains the slowest of these steps, and the placement process overview shows the full sequence from first contact to first shift.
How we get your Green Form ready to file
Our placement desk works toward one result: a Green Form you can send with the first box checked. We find a preceptor near home who fits your practicum, confirm the site has approved the rotation, name the administrative contact, and have the CV, license and certification in hand so the credential step moves the day NAU asks.
Everything is timed against the March 31, June 30 and October 31 cutoffs, or the earlier dates if your cohort follows them, and you learn at the start whether the site will need a new affiliation agreement. For FNP students we lay out all three practicums at once, so the summer, fall and spring forms each go in on time. Share your course and term on the contact form.
Questions NAU students ask
Is the Green Form the same as the affiliation agreement?
No. The Green Form is your request, filled in by you and sent to NAU's clinical coordination team. The affiliation agreement is a contract between NAU and the clinical agency, started by NAU from the details on your form when none exists. A site can already have an agreement on file and still need a Green Form for your rotation.
Can my preceptor fill out the Green Form for me?
No. The form names the student as the person who completes it, and the 2021-22 version told students not to send it to the proposed site to fill in. Your preceptor's part is supplying a CV or resume, license and any specialty certification, which NAU reviews before approval.
What if I miss the Green Form cutoff?
Contact the Clinical Placement Coordinator at once. The 2022-23 form says late requests may not be completed before the target semester begins, which leaves some room but no promise. Have your preceptor's documents and the site's approval ready so the request can move fast, and see our page on finding a preceptor fast if time is short.
Do PMHNP students use the Green Form?
Possibly, but no readable source confirms it. The handbook that covered PMHNP students in 2023-24 is offline with no archived copy, and search-engine text hints that it used the same form. Ask your PMHNP program coordinator for the request form and the cutoffs that apply to NUR 680.
Do I need a new Green Form for each practicum?
Plan on one for each new preceptor. The guidelines begin the procedure whenever a student identifies a potential preceptor or mentor, so a new name for NUR 663 or NUR 665 means a new form. If the same preceptor continues with you into the next term, ask the Clinical Placement Coordinator whether a fresh request is needed.
Related pages
Last checked 2026-09-27
We check these pages against Northern Arizona University's own catalog, program pages and published nursing documents. Your program coordinator and course faculty have the final word.
NAU welcomes a preceptor you arrange. We arrange one close to home.
Tell us your NAU track, your town and your next practicum. We line up preceptors who fit the course and Arizona's preceptor rule, confirm the site's approval, and gather the CV, license and certification the Green Form needs, well before NAU's cutoff.
- Preceptors matched to the course: all-ages family primary care for FNP, psychiatric settings for PMHNP
- License, experience and certification checked against the rule NAU applies, before the Green Form goes in
- All three FNP practicums planned together, near home instead of a long drive away
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