---
title: "Clinical Consent Form"
type: "wiki"
space: "Seneca Nanji Foundation School of Nursing"
author: "Deena Douara"
created: 2026-10-27T15:18:11Z
updated: 2026-10-30T18:15:23Z
tags: ["clinical", "clinicalconsent", "clinicalpackage", "consent"]
url: "https://students.senecapolytechnic.ca/spaces/312/seneca-nanji-foundation-school-of-nursing/wiki/view/18512/clinical-consent-form"
---

# Clinical Consent Form

#### Clinical Consent Form - Seneca Nanji Foundation School of Nursing

In order to facilitate a Seneca authorized clinical practicum placement, Seneca is required to collect, use and disclose personal information to assist in establishing the placement, supporting students throughout the placement, and monitoring and evaluating successful completion of the placement.

The consent form **only needs to be completed for the "first" clinical placement** and lasts for the duration of the program. Please note that this applies to all programs under the School of Nursing.

Download the **[Clinical Consent Package](https://students.senecapolytechnic.ca/attachment?file=iZNCi%2BtF7BbWlkUkjGqIxw%3D%3D)** here.

Upon completion of the Clinical Consent Package with signature, email the [Clinical Consent Package](https://students.senecapolytechnic.ca/attachment?file=iZNCi%2BtF7BbWlkUkjGqIxw%3D%3D) to Noreen Champagne at noreen.champagne@senecapolytechnic.ca

Please include the information from the Example Draft Email.

**EXAMPLE OF DRAFT EMAIL**

**![](https://students.senecapolytechnic.ca/attachment?file=aDMcbQewdKCPvLRSKiUfzw%3D%3D)**

Note: If you do not submit the clinical consent package, you will not be able to receive important correspondence about your placement.

## Attachments

- [Student_HSPnet Consent Forms.pdf](https://students.senecapolytechnic.ca/attachment?file=iZNCi%252BtF7BbWlkUkjGqIxw%253D%253D)
- [Screenshot 2026-10-28 110007.png](https://students.senecapolytechnic.ca/attachment?file=aDMcbQewdKCPvLRSKiUfzw%253D%253D)