• COVID-19 Vaccine Exemption Instructions and Form

• Affiliation Agreement Request Form
• Out of Service Area Affiliation Data: Word | PDF

• Medical Clearance Form (Return to Clinical)

• HIPAA Training Module and Test
• HIPAA Breach Notification Process
• HIPAA Clinical Event Notification

Our clinical partners require that all students who participate in clinical are required to complete an N95 Fit Test. This test is paid for by the college. However, you will need to pick up your kit. Follow these instructions:

1. Pick up your Fit Test Kit from the Eastview Campus Nursing Office or the Round Rock Campus Nursing Office Monday through Wednesday between 8:30 a.m. and 3:30 p.m. If you are unable to pick up your fit test kit during this timeframe, please contact one of the following Cohort Administrators for alternate arrangements.
   • Eastview Campus: Sheila Rodriguez, [email protected], 3401 Webberville Road, Austin, TX 78702, Bldg. 8000, Rm. 8227
   • Round Rock Campus: Malanie Soliz, [email protected], 4400 College Park Drive, Round Rock, TX 78665, Bldg. 3000, Rm. 3237.00
2. Test Kits include:
   • Concentra voucher (the list of Concentra locations authorized to fit test are on the back of the voucher)
   • Masks
   • Instructions for fitting the mask to your face and instructions regarding facial hair, if applicable
3. Fill out the top part of the Concentra voucher with your information.
4. Take the kit to one of the authorized Concentra locations (locations offering the testing are on the back of the voucher form).
5. Do not skip this step. Once the tech has completed the fit test, ask for a copy of your results or take a picture with your smart phone. The results are not sent back to the Nursing Department. You must obtain a copy and upload your results to the link below. Save this document in a safe place. It is an official record.
6. Once you have completed the fit test, please confirm your mask brand and size with the staff performing the fit test before you leave the facility (sometimes the information written on the form is difficult to read).
7. Upload a copy of your fit test results to this Google Form (you will be required to log into your ACC Gmail Account in order to complete the form).
8. All students are required to watch this safety video prior to going to any clinical sites. Students who do not complete this requirement will be unable to attend clinical.

• Master Attestation Form
• Attestation Form (Diagnostics and Therapeutics, Pharmacy, and Imaging only)
• Attestation Form and Pre-Placement Requirements (OTA/PTA Rehabilitation Services only)
• Badge and Parking Directions
• COMPASS Access Agreement for Faculty
• COMPASS Access Agreement for Students
• COMPASS Training (MyLearning) Form (Faculty only)
• Pre-placement Requirements Modules

• Guidelines for Imaging Students
• Visitor or Student Confidentiality Agreement

• Clinical Rotation Attestation Letter
• COVID-19 Vaccination Exemption Form
• Education Affiliation Agreement Checklist
• Allied Health Student Orientation Instructions
• Online Orientation
• Network System User Agreement
• Nursing Student Orientation Acknowledgement of Completion
• HIPAA Training Acknowledgement
• Student Substance Abuse Policy

• Clinical Placement Instructions
• Clinical Rotation Checklist
• HIPAA Training Acknowledgement
• Student/Independent Contractor Confidentiality Agreement
• College Student Compliance Safety Quiz
• Orientation Packet

• Online Orientation Process
• Completion of CSR Orientation Certificate for Faculty
• Completion of CSR Orientation Certificate for Students
• Notification of Experience – Single Student
• Notification of Experience – Multiple Students
• EPIC Computer Access Request Form
• Vaccination Verification Ancillary
• Immunization Exemption Form
• Verification Form

• Clinical Rotation Checklist
• Confidentiality Agreement
• HIPAA Student Training
• Hospital Orientation In-Service
• Information Security Compliance Form
• Mini-Orientation
• Student Database Form

• Student Checklist (updated May 20, 2022)

• Accudose Security Agreement
• Attestation Form (updated May 24, 2022)
• Faculty Orientation Manual
• Student Orientation Manual
• Mandatory Orientation Module and Post Test
• Statement of Responsibility
• Meditech Access Request Form and Confidentiality & Security Agreement
• ICARE My Commitment to Our Values Form
• Substance Use in the Workplace Acknowledgment (New as of Fall 2022)
• COVID-19 Self-Screening Attestation Form (New as of Fall 2022)
• USP <800>: Safe Handling of Hazardous Drugs Module and Post Test
• Bridging the Gap Modules (Complete Modules 1-4 only)