THE PRECEPTOR SITE

Preceptorship Intake Form

Tell us about yourself and your rotation needs. Once submitted, our team will follow up with your preceptorship agreement and invoice.

Step 1 of 4 — About You

About you

Your basic contact information.

First name *

First name is required.

Last name *

Last name is required.

Email address *

A valid email is required.

Phone number *

Phone number is required.

Current mailing address (optional)

Program & rotation details

Information about your school and the placement you're requesting.

University / College *

University is required.

Degree / Program *

Please select your program.

Semester / Quarter *

Please select a semester / quarter.

Total clinical hours required *

Please enter the number of hours required.

Requested start date *

Start date is required.

Requested end date *

End date is required.

I need an additional rotation period

University supervisor name (optional)

University supervisor email (optional)

Documents & notes

Share links to your resume and school handbook if you have them.

Resume link (optional — Google Drive, Dropbox, etc.)

No link handy? Upload the file directly below instead.

Upload resume (optional — PDF, Word doc, or image, up to 3MB)

School clinical handbook link (optional)

Clinical focus / objectives (optional)

Anything else we should know? (optional)

Review & submit

Double check everything looks right before you submit.

You're all set!