Preceptor Interest Form

Are you ready to take the next step in helping to develop future generations of nurses? The UR School of Nursing is in need of highly-qualified clinicians from across the Western New York region with a minimum of one-year experience as a certified health professional (e.g., NP, CNM, PA, or MD/DO).

Fill out this form and we will contact you and guide you through the process of becoming a preceptor.

Items marked with * are required.

* First Name:

* Last Name:

Credentials:

Address:

City:

State:

Zip code:

Phone:

* Email:

* Practice setting/Site:

Title:

Work Address:

City:

State:

Zip code:

BusinessPhone:

Additional Information: