UC's extra state forms for California, North Dakota and Wyoming

Which states, and what UC asks for

Three states add paperwork to a UC clinical: California, North Dakota and Wyoming. UC's Clinical Planning page and its Becoming a Preceptor page both flag them, and the Clinical Planning Checklist (May 2026) lists state board forms as their own item.

The instruction is short. Send the state form to UC's state authorization mailbox, constateauth@uc.edu, at least one week before the semester begins, and keep it out of the preceptor packet. The packet goes to your CSC, or to the address your CSC gives you, on UC's packet schedule. The state form travels separately to a different inbox.

California: one BRN preceptor form per preceptor

California's form comes from the state's Board of Registered Nursing: the "Nurse Practitioner Program Preceptor Form," tied to California Code of Regulations Title 16, section 1486. UC needs one for every California preceptor, so a term with two preceptors means two forms, and a new preceptor later in the program means another.

The BRN form also points to a separate Verification of Clinical Practice Experience form. UC's pages don't say whether UC needs that one from you as well, so ask at constateauth@uc.edu when you send the preceptor form.

California also changes one track's preceptor rules. For PMHNP Internship I, UC normally wants a licensed psychotherapy provider such as a social worker, counselor or psychologist. California swaps in a different list for that first internship: nurse practitioners, physicians and clinical psychologists, or a psychiatrist if the program director agrees. Check that before you ask a California therapist to precept you; PMHNP internships has the full sequence.

North Dakota: the facility signs

North Dakota's form is about the site rather than the person. UC's Facility Availability Verification is signed on behalf of the clinical facility and returned to constateauth@uc.edu. The right signer is someone who can speak for the facility, which may not be your preceptor, so ask early who that is and how long a signature usually takes there.

North Dakota also sits on UC's short list of states where a PA can be considered as a preceptor, with limits on hours. If a PA is part of your North Dakota plan, clear that with your CSC separately; the facility form doesn't settle it. PA preceptors explains the limits, including the hours a PA can't cover.

Wyoming: confirm the form first

Wyoming is where UC's pages disagree. The Clinical Planning page's deadline table names Wyoming alongside California and North Dakota but links forms only for those two. The Becoming a Preceptor page, written for clinicians, does link a Wyoming form: the Wyoming State Board of Nursing Faculty Qualification Sheet, with a 2016 date on the form itself.

Given that gap, don't assume the linked sheet is the whole requirement or the current one. Before your Wyoming preceptor fills anything in, email constateauth@uc.edu or ask your CSC which Wyoming form UC wants for your term and who should complete it. Keep the reply with your clinical records.

Timing: collect the form alongside your packet

One week before the semester is the floor, not the plan. A form that lands that late leaves no time to fix a missing signature, and hours can't start until your site is fully cleared. The easier route is to gather the state form while the preceptor works on the Preceptor Application, then send it on its own.

1. Flag the state earlyWhen a preceptor in California, North Dakota or Wyoming says yes, tell your CSC the site's state so the extra form is on everyone's list.
2. Get the right formUse the California or North Dakota form UC links, and confirm the Wyoming form before anyone uses it.
3. Collect signatures with the packetAsk the preceptor or facility to complete the state form while they're completing the Preceptor Application.
4. Send it separatelyEmail the state form to constateauth@uc.edu, never inside the preceptor packet, at least one week before the semester.
5. Keep proofSave the sent email and a copy of the signed form in case your CSC or the site asks for it later.

UC's online programs start their next terms on January 11, 2027 (spring), May 10, 2027 (summer) and August 23, 2027 (fall), so count back a week from the date that applies to you. Packet dates are on UC's packet deadlines.

What the state forms don't replace

A state form is an added layer, not a shortcut. Your California, North Dakota or Wyoming preceptor still completes the Preceptor Application after your student section, the site still needs an Educational Affiliation Agreement before any hours, and you still need an RN license valid in that state.

Some things these states don't add. None of the three is on the handbook's list of 18 states that require a supplemental state background check for APRN students, so the extra step here is paperwork, not another screening. Site onboarding is separate again: a California hospital can have its own platform and modules whatever the BRN form says.

The affiliation agreement page covers the agreement, and state authorization covers where UC can place clinicals at all.