Certified Preceptor – Preceptor Training Certification

First Name*

Last Name*

Title*

Organization*

Course Title*

CE/CME Hours*

Sponsoring Organization*

Certifying Exam Certificate*

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Question/Statement 1: Discuss your experience and journey as a preceptor. Include details as to when you first precepted, how many preceptees you have trained, what types of preceptees you have trained (students, new graduates and/or new hires), and any other information about your history as a preceptor. (500 word limit)*

Question/Statement 2: What are your strengths as a preceptor? What are areas for improvement you have identified and how have you addressed them? (500 word limit)*

Question/Statement 3: In what ways have you supported preceptees (students, new graduates, and/or new hires) beyond preceptoring? (250 word limit)*

Question/Statement 4: What recommendations do you have to further support preceptors and what tools and resources might you develop or promote to help preceptors (and preceptees) be successful?*

Letter of Recommendation 1*

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Accepted file types: doc, docx, pdf, Max. file size: 2 GB, Max. files: 1.

Letter of Recommendation 2*

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Accepted file types: doc, docx, pdf, Max. file size: 2 GB, Max. files: 1.

Curriculum Vitae (CV)*

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Accepted file types: doc, docx, pdf, Max. file size: 2 GB, Max. files: 1.

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