Preceptor Contact Form
Preceptors are an integral part of Rocky Vista University as they give our students hands-on training in the real world with real patients.
Date of Birth
If other, please explain:
Certification Type (ABFM, FACOFP, etc.)
Certification Expiration Date
Licensure Type (e.g. Medical)
Licensure Expiration Date
List the hospital(s) used in your clinical practice (to ensure we have appropriate Affiliation Agreements):
Have you had any prior experience precepting/teaching medical students, residents, fellows, nurses, nurse practioners, physician assistants, or EMTs?
Students Accepted for Rotation (REQUIRED):
Would you like an Adjunct Clinical Faculty Appointment from Rocky Vista University?
Please attach your CV below:
Please attach your Certificate of Insurance (COI) below:
COI Expiration Date
Would you like online access to the Frank Ritchel Ames Memorial Library at Rocky Vista University?
Name of RVU Clinical Coordinator or Student you are working with (if applicable)
If you have any questions, please contact the Office of Clinical Affairs at 720-875-2845 or firstname.lastname@example.org.
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