WSU College of Nursing Preceptor Application

Fields with asterisks (*) are required.

Personal Information

First name

Last name *

Email *

Credentials *

Board Certified *

Yes

No

Specialty *

Number of Years Preceptor Experience

Attach copy of Resume/CV. File must be one of the following document types: DOC/DOCX, PPT/PPTX, XLS/XLSX, RTF, TXT, PDF, ZIP, GIF or JPG/JPEG *

Practice/Group Name *

Practice Manager

Practice Manager Email

Phone Number

Address line 1

Address line 2

City

State

Postal/zip code