SHOW Clinical Preceptor Application

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Thank you for your willingness to volunteer with SHOW as a preceptor. Preceptors are licensed, practicing health professionals who give personal instruction, training, supervision, and mentorship to students. If you are a student, the student service learning application can be found in your Canvas course shell (all student volunteers must be enrolled in one of SHOW's service learning courses).

A full list of volunteer requirements can be found attached to this document. Do not submit them at this time. After reviewing your application we will send you an email with any additional paperwork and a list of requirements for submission.

For questions, please email SHOW's Admin Associate, Tammy Krause, at tamara.m.krause@asu.edu. We look forward to working with you!

Email *

First Name *

Preferred First Name

Last Name *

Professional Specialty *

Employer *

Employment Address

Home Address

Work Phone

Cell Phone

University Affiliation (if applicable)

Arizona State University

Northern Arizona University

University of Arizona

Other:

Who were you referred by (if applicable)?

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