FCHC Demographic Form - OLD DONT USE

Fairfield Community Health Center (FCHC) is committed to providing competitive educational experiences for students in various health professions at both undergraduate and graduate levels. Preceptorship opportunities are available for medical students, physician assistant students, APRN students, behavioral health students, and medical assistant students. 

The following application questions assist FCHC to evaluate your needs for clinical preceptorship and our ability to provide you with a unique and tailored learning experience. 

The documents provided in the following pages must be downloaded, completed, and uploaded later in the application process. 

Please complete all questions in the program application. Failure to complete all application questions may result in the dismissal of your application. 

Thank you and good luck in your educational pursuits!

Any questions regarding this application should be directed to amurfin@fairfieldchc.org.