Preceptorships Application

Preceptorships
Student Application

Please have all review our requirement and prepare all required documents before submitting your application.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Emergency Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

List language(s) you speak in addition to English *

Current school or institute name *

Name of school contact *

Email of school contact *

Why are you interested in the clinical experience at Amed Family Clinic? *

Updated HIPPA Certificate *

Max file size: 20MB

Immunization Record *

Max file size: 20MB

You agree to our Privacy Statement and Clinical agreement & privacy statement by clicking submit.

Submit

If you represent an institute, university or training program and would like our clinic to be your clinical preceptorship site or affiliate, please contact us directly at education@amedfamilyclinic.com

What are our requirements:

Must be at least 18 years old
Complete the preceptorship application
Review clinic agreement
Sign our preceptorship agreement once your application is accepted by our education department.
Have updated immunization record
Complete the FREE HIPPA training and provide a copy of the certificate (link)

Due to the high demand and interest, our team needs 2-4 weeks to review applications and provide feedback.