Duquesne Health Sciences
Preceptor/Clinical Instructor Info Form
Name
*
First Name
Last Name
Company / Employer
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number
Format: (000) 000-0000.
Are you a DU Alum?
Yes
No
Back
Next
Program Information
Program(s) of Interest - check all that apply
*
Athletic Training
Health Administration
Health Sciences
Occupational Therapy
Physical Therapy
Physician Assistant Studies
Public Health
Speech-Language Pathology
Are you a current preceptor or clinical instructor?
Yes
No
If yes, would you like to receive information on how to take advantage of the benefits available to you?
Yes
No
Would you like to receive info and/or be contacted about becoming a preceptor or clinical instructor?
*
Yes
No
Please enter any comments below that may help us learn more about you and your preceptor location:
Submit
Should be Empty: