Student System Access Request Form

This form is used to access Cerner eKiDs Clinical system. A separate form must be submitted for each student and instructor set up security access.

Note: Required fields are marked with an asterisk (*)
Required Instructor Information
Required Student / Instructor Information
MM/DD
RadDatePicker
RadDatePicker
Open the calendar popup.
Additional Student / Instructor Information
RadDatePicker
RadDatePicker
Open the calendar popup.
 to 
RadDatePicker
RadDatePicker
Open the calendar popup.