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Preceptorships

Preceptor Application

  • Clinic Information

  • Please include all specialties and other information about your clinic/practice that student learners should know before calling you.
  • Practitioner Information

  • Use your full professional name as it appears on your license(s). If your name includes a middle initial, add this to the end of your first name.
  • An email address that students can use to contact you.
  • A phone number students can use to contact you.
  • Please list everything that you require from a student learner. Examples include but are not limited to: class level, program, interviews before placement, dress code, etc.
  • List all licenses using the fields below. If you have multiple licenses, please use the (+) icon to add a new set of fields.
    License NumberStateCountryCredential 
  • All preceptors must agree to the policies stated in NUNM's Student Handbook. Please read the NUNM preceptor policy and check this form field if you agree.