Kirksville College of Osteopathic Medicine Request for Preceptor CME Credit
This form is specifically for KCOM third and fourth year students

To request credit for SOMA students, please visit: https://www.atsu.edu/soma/cme/preceptor_credit.asp

Call the Missouri AHEC Program (660.626.2887) to request credit for Early Clinical Experiences (second year students).

Thank you for serving as a Preceptor for third and/or fourth year KCOM medical students. Please complete the form below to request your CME credit. CME credit is processed on a quarterly basis (March, June, September, December). Your request will be processed and sent to the CME office during the corresponding quarter based on the date of the request.

Questions: Clinical Affairs 660.626.2513
Email *
Are you a D.O. or M.D.? *
DO Physicians
For Osteopathic Physicians:
Osteopathic physicians serving as preceptors in any AOA approved osteopathic medical education program may be granted Category 1-B credit. A maximum of 60 hours of AOA Category 1-B for preceptoring may be applied to the 120-hour requirement. Upon receipt of the completed Clinical Performance Evaluation for the rotation, CME credit will be confirmed. Credit for osteopathic physicians is submitted to the AOA on a quarterly basis (April, July, October, January).
AOA Number (If Applicable)
Physician First Name: *
Physician Last Name: *
Phone Number: *
Rotation Type (i.e. surgery, family medicine, pediatrics): *
Student's Name: *
Start Date of Rotation: *
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End Date of Rotation *
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Number of Hours Requesting: *
A copy of your responses will be emailed to the address you provided.
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