We are now accepting submissions for Spring 2024.
Deadline is June 25th, 2024.

Complete this survey if you want to receive a cash incentive payment for your time and effort in precepting a nursing student.

Payments can take up to 8-10 weeks after each reimbursement cycle deadline.

For information about deadlines, how to apply for a Statewide Vendor Number, or for help completing this form please visit the Preceptor Program Webpage at: https://nursing.wa.gov/education/student-nurse-preceptor.

  • Deadlines apply for all submissions and submissions after the deadline cannot be processed.
  • Apply for a Statewide Vendor Number at the beginning of the preceptorship.
  • Submit form as soon as you complete 80 hours of preceptorship.
  • It is the responsibility of the preceptor to complete and submit the form by the deadline.
  • Answer every question unless listed as optional.
  • Out-of-state nursing program students are not eligible for reimbursement, even if the clinical hours take place in Washington.
  • You must be an LPN, RN, or ARNP to qualify for reimbursement.

Reimbursement Cycles
We are currently accepting reimbursement submissions for the Winter 2024 cycle.
Reimbursement Cycle

**Duplicate submissions may cause delay in payments.

Question Title

* 1. First Name
(Legal name)

Question Title

* 2. Last Name

Question Title

* 3. Statewide Vendor Number (SWV) (Required)
To qualify for reimbursement, you must have a Personal Statewide Vendor Number. To apply for your Statewide Vendor Number, click on the following Link:
Vendor payee registration | Office of Financial Management (wa.gov).

You must have a SWV number to complete the application. Please apply with the Office of Financial Management (OFM) and get a SWV number prior to sending in the preceptor hour reporting form. Each preceptor must have an individual SWV number, we cannot make payments to a business even if you are the business owner. We do not accept business or DBA (Doing Business As). Please use your SSN when registering for a SWV.

Instruction on how to apply for a SWV number is on our website.
Student Nurse Preceptor | WA Board of Nursing

Note: Please do not put down your SSN, Healthcare License Number, or Phone number. We will cannot process your reimbursement without this unique number obtained from OFM.

Example: SWV0123456-00.

Question Title

* 4. Last 4 digits of Social Security Number

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* 5. Date of birth

Date

Question Title

* 6. Healthcare License Number
      State and Federal government nursing employees:
  • You should confirm that you won't violate State or Federal ethics laws before submitting.
  • Consider contacting your leadership team to verify.

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