Common Contracts

Preceptor Agreement Form Deadlines: Fall Semester. – Due May 15th Spring Semester – Due October 15th Summer Session – Due March 15th

Preceptor Agreement • June 7th, 2022

• Contract Type
  Preceptor Agreement
• Filed
  June 7th, 2022

Preceptor Name: _______________________________________ Highest Degree: ___________________________ Preceptor Phone: ____________________ Preceptor Email: ________________________________________­____ Preceptor Prof. License #: _________________________________ Type of License: ___________________________ Licensing Agency: ______________________ Issuing State: _____ Expiration Date: ___________________________ Does preceptor have at least 2 years of relevant preceptor experience? Yes ☐ No☐ List relevant experience pertaining to student’s area of focus: (i.e. Leadership, management, policy, Peds, NP, women’s health, gero) _______________________________________________________________________________________________ Areas of Certification: ____________________________________________________________________________ Is Preceptor the Student’s Direct Supervisor at work (student’s place of employment)? Yes ☐ No☐ Has the Preceptor previously precepted for Mennonite College of Nursing studen