Student Forms

1)   Student Medical Certificate - Faculty of Nursing: for student absences due to illness

2)   Forms in Case of Student Accident or Injury:
Students in unpaid clinical placements are covered by the Workplace Safety Insurance Board (WSIB). You must inform your clinical instructor, who will supervise the steps you need to take.

The University must submit a report to WSIB if a student's accident results in an injury that requires or results in:
a) health care by a medical practitioner (this could include a physician, dentist, hospital, chiropractor, etc.) and/or
b) lost time from clinical beyond the date of the accident, or
c) exposure to a communicable disease

Instructions:

  • Please immediately contact the Faculty of Nursing Clinical Coordinator or Clinical Placement Secretary to report the injury, as they must report the student’s name and injury to Human Resources/Employee Health within 24 hours of the incident. The completed written report(s) may follow by the next day or sooner if possible.
    Contact info: Natalie Bownes (Clinical Coordinator) - 519.253.3000, x4814 or nbownes@uwindsor.ca or Susan Rotondi-Moore (Clinical Placement Secretary) - 519.253.3000, x4918, srotond@uwindsor.ca.
  • Instructor and student must complete report(s) and submit to to the Clinical Coordinator or Clinical Placement Secretary (contact info above) as soon as possible following an injury – within 24 to 48 hours of injury occurrence. Note: For needle stick injury or fluid spash, please complete both the Accident/Incident Investigation Report and the Needle Stick and Fluid Splash Report.
  • If a client is involved - please do not include the client's name in the report; just include the injured student's information, as well as agency staff who may have witnessed or treated the injury.
  • Forms are usually required to be completed for the agency/organization as well. Please check with your respective placement agency/organization to follow their practice as well.

3)   Consent for Disclosure - This document authorizes the University of Windsor's Faculty of Nursing to disclose a student's academic/student records to an outside institution.

4)   Authorization and Direction - This document authorizes another institution to disclose a student's academic/student records to the University of Windsor's Faculty of Nursing.

5)   Reference Release Form - This document authorizes the University of Windsor, Faculty of Nursing to forward references as requested.

6)   Nursing Make-up Examination Request Form
To be used in accordance with the Nursing Missed Examination and Missed Assignment Policy. Note: Student Medical Certificate must be completed and submitted for medical reasons.

7)   Statement of Honesty Template - for Assignments
Students download this form, then complete and attach to assignments submitted to the Faculty of Nursing.

8)   Returning Nursing Student Form

9)   Pre-clearance Forms

10) Police Clearance Request Forms

11)  Request for Consideration of Clinical Absence Form

12) Other forms:

The following forms can be found on the Registar's website (under "Forms and Applications"):

  • Application for Alternative Final Examination(s) Due to 3 Exams Scheduled on the Same Day
  • Add/Drop Course Change Form
  • Grade Appeal/Aegrotat Form. Note: at least 60% or more of the course work must have been completed to qualify for an aegrotat grade in the Faculty of Nursing.
  • Alternate Exam for Religious Conviction Form
  • Letter of Permission Request to take Course(s) at another university for transfer credit
  • Diploma/Certificate Reprint request