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* 1. Name

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* 2. Credential (RN, APRN, etc.)

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* 3. Education (ASN, BSN, Masters, Doctorate)

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* 4. Email

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* 5. Phone

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* 6. What healthcare organization are you a part of?

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* 7. What is your position (job)?

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* 8. Are you currently a preceptor?

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* 9. What school are you affiliated with as a preceptor?

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* 10. What type of individual are you currently precepting?

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