APP Preceptor Availability 2019

Please identify your availability for precepting a student for the spring 2019 semester. Please answer all questions as accurately as possible in order for us to make informed decisions with placement. THANK YOU!
 
Reminder: Precepting hours can count toward CME/Accreditation.

PLEASE ANSWER QUESTIONS 1-9 IF YOU ARE WILLING TO ACCEPT A STUDENT.
 

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* 1. First and Last Name

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* 2. What is your ROLE?

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* 3. Rotation Options

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* 4. How many years of experience as a APRN/PA/MD?

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* 5. Have you served as a clinical preceptor in the past in any capacity?

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* 6. What is your practice specialty?

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* 7. Where is your practice?

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* 8. Where is your clinic location?

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* 9. Do you have OR privileges?

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* 10. Please note any specifics that need to be considered for this rotation, such as vacation, maternity leave, FMLA, etc.

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