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PICC Clinical Qualification Program Application-DOWNLOAD

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 Product Description

Notice 02/24/16: We are not accepting new applications to this program at this time. The PICC Clinical Qualification Program is on hold until further notice.

This is the place to download the application and confidentiality forms for the program only.  Completion of the registration/order for the forms within this section is required. There is no charge to download the forms.

The PICC Clinical Qualification Program is a PICC and Midline insertion clinical training program.  We have worked closely with a clinical leader in PICC insertions for several months to develop this opportunity.  Application to this program is available to clinicians that have successfully completed qualified PICC Resource Associates, LLC or PICC Excellence, Inc. PICC and Midline Insertion classes.


Clinical Site:

The PICC Clinical Qualification Program clinical sites are in Indiana and Illinois.  We have a contract with a company to make this clinical opportunity available to our customers.  Choose a clinical time from 4 days to up to a full week (7-day) program. 



  • Supervision is one-to-one
    • Training adapted to trainee needs
  • Learn from the best. The PICC preceptor:
    • Is certified as a CRNI and VA-BC
    • Has many years of experience in PICC precepting
    • Has inserted thousands of PICCs and Midlines
  • Learn advanced technology. Insertions performed using: 
    • Modified Seldinger Technique
    • Ultrasound Guidance
    • ECG tip confirmation (for PICCs)


Don't Settle for Less: PICC line insertion procedures are advanced vascular access procedures. We are committed to evidence-based practice and helping trainees become confident and competent. We have done our best to put together one of the most comprehensive PICC clinical training programs available. It is important that trainees are taught according to national vascular access guidelines and infusion standards of practice. The preceptor's dual credentials of CRNI and VA-BC tells trainees that the preceptor is nationally certified as an infusion and vascular access specialist, and it exhibits our commitment to higher standards.

Details on the clinical site(s) are provided upon application acceptance and/or when we receive the completed inquiry forms.  A range of program date choices can be requested, but dates cannot be confirmed until full payment has been received. 


What to Expect:

The number of successful PICC and Midline insertion procedures by a trainee cannot be guaranteed.  However the average rate of insertions is from 15 to 25 PICCs and Midlines per week. Trainees within the week-long program should have an opportunity to attempt a minimum of 15 PICC and/or Midline insertions.

Upon payment in full or payment of the program deposit; the applicant accepted into the program will be sent a video on sterile technique to view and study for a post test on clinical day one. 

On day one of the the training program, the trainee will take a post test on the video and will work with the preceptor to review and demonstrate sterile technique and set up prior to starting the first PICC or Midline insertion case of the day. Day two to end of clinical period, trainee will follow the preceptor and will be supervised in performance of live PICC insertions for each remaining day of clinical program.

Upon completion of checkout and payment for this order, a download of the program application, information flyer, and the program Confidentiality Form will be available to you for download via a link within the email sent to you automatically by our order system.

Fees and Financing Options:

Full Payment: The introductory price for the training program is $2,000.00 for four days, with additional days can be added at $500.00 per day, up to $3,500.00 for a full week of training (seven days)! The fee includes lodging in a hotel room (see the application and program info flyer for details).  This pricing is below average for the time period of training, added added advantage of an included room. (Airport transportation is not included for this program).

Deposit & Payment Plan: A non-refundable deposit of 25% may be paid with the program application, the balance is payable via our 3 to 4 month payment plan. Fee for payment plan: adds $100.00 to initial down payment. Additional details are included on our website and on the application form (download of the application is made available upon completion of checkout).

To pay the deposit only (with remaining balance payable up to 2 weeks prior to the clinical start date), call customer support at (888) 459-4913, option 1 Monday through Friday weekdays 9AM to 5PM Eastern Time, leave a message if not immediately available).

Other program requirements:

Trainees must meet the clinical site and state clinical requirements, and meet the average requirements for vaccinations, etc. to work within a clinical area and perform procedures on patients. A list of required documentation to verify eligibility requirements have been met are listed on the program application. 

Refund, exchange, returns, and cancellation policies are included on our website at: https://cart-catalog.piccresource.com/refund-cancellation-policies-disclaimer/ .  

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