Certified Preceptor – Preceptor Training & Certification

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Highest Degree Earned*

Years Experience as a Preceptor*

Continuing Education in Preceptoring [25 Contact Hours Required]

Course Title	Contact Hours	Course Date	Sponsoring Organization

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TOTAL CONTACT HOURS:

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. (250 word minimum; 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? (250 word minimum; 500 word limit)*

Question/Statement 3: In what ways have you supported preceptees (students, new graduates, and/or new hires) beyond preceptoring? (100 word minimum; 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? (50 word minimum; 250 word limit)*

Letter of Recommendation 1*

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Letter of Recommendation 2*

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Curriculum Vitae (CV)*

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