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Student Learning Experience Engagement Form (SLEE)

Thank you for your interest in utilizing CoxHealth as a site for your learning experience or clinical rotation! Please read the following information carefully to ensure a successful and timely application process.

The Student Learning Experience Engagement form (SLEE) is required to be submitted once per rotation/experience. This form confirms with the Education Center the details of your learning experience or rotation. The Education Center will grant computer access on your student account only for the dates written on the SLEE form. If your rotation dates change in any way, you must submit an updated SLEE form. The Education Center cannot guarantee computer access without a SLEE form.

Please note that it takes 2-3 business days to reactivate your student account once the Education Center is notified of a date change. The Education Center can only reactivate computer accounts during business hours (Monday – Friday 7:30 AM – 4:00 PM).

Frequently Asked Questions
What if I have multiple preceptors or CoxHealth supervisors?
•If you have two preceptors at the same location during the same date range, only one form is required. Please be sure to write both of their names on the form as this information is used for multiple data points.
•If you have two preceptors at different locations during the same date range, please submit one form per preceptor. Write in the number of hours you will spend with each preceptor on each form. Example: If you are completing a total of 120 hours between two preceptors and you know your time will be split evenly with each preceptor, write “60 hours” on each form.
•If you have three or more preceptors, please only list the name of the manager of the clinic or hospital unit where the rotation is taking place and write “multiple preceptors” next to manager’s name.
What if I do not know my preceptor’s name?
•Contact the Education Center at, or contact your school for more information.
In making application as a Student to CoxHealth:

I hereby authorize and consent to hospital representatives consulting with prior, current and/or future associates or others who may have information bearing on professional or ethical qualifications and competence and consents to inspection of all records and documents that may be material to evaluations of said qualification and competence;

Accordingly, I hereby authorize and direct you and anyone designated by you and acting on your behalf, and every educational, hospital, or other medical facility, physician, other health care professional, governmental agency, including the National Practitioners Data Bank, association or institution having control of any documents, records, reports, and statements, and information of any kind whatsoever, pertaining to my association to release and give to CoxHealth (as requested by it) any and all records, reports, statements information of any kind and description.

I hereby release from liability all those who, review, act on or provided information regarding my competence, professional ethics, character, health status, and other qualifications for staff appointment and clinical privileges. I further attest to the correctness and completeness of all information furnished. 

I hereby understand that nothing herein shall be construed as creating an Employee/Employer relationship between CoxHealth and myself. I will hold CoxHealth harmless for any injuries to me as a result of being on the CoxHealth premises for my own benefit.
This question requires a valid email address.
8. Select the location where you will need charting access for this rotation. If no charting access is being requested, select N/A. *This question is required.
This question requires a valid date format of MM/DD/YYYY.
This question requires a valid date format of MM/DD/YYYY.
This question requires a valid number format.
13. Student Signature *This question is required.
Signature of