FNP Preceptor Request Form
The Preceptor Request Form is a Microsoft Form that it utilized to collect data from students regarding their intended practicum experience. Students are expected to complete the form for each clinical experience they are requesting. Information will only be accepted via this form as it captures all necessary information and creates a timestamped log of the request (emails can get overlooked).
Submission of this form starts the formal request process:
- Student networks and identifies a preceptor (if allowed to do so by agency)*
- Student submits Preceptor Request Form
- Request is reviewed by Clinical Placement Coordinator
- Coordinator requests clarification of any details from the student, if needed
- Coordinator consults with Graduate Program Director for approval, if required
- Coordinator submits request to the health care agency following their timeline and process
- Approval or denial of the request by the health care agency
- Student completes onboarding and orientation requirements of the health care agency
* Review the "Clinical Placement Information" tab in MO2 before reaching out to any potential preceptor/agency. If the agency you desire to work with does not want students to contact preceptors, just enter N/A in all fields with specific preceptor/clinic information.
Even if your preceptor has agreed, the request is not considered approved. Formal approval must come to you via email from the Clinical Placement Coordinator. Some agencies will reach out directly to the student with approval. Please forward this on to the Clinical Placement Coordinator at clinicalpaperwork@marianuniversity.edu for confirmation before making arrangements with your preceptor.
If your request is denied, the Clinical Placement Coordinator will work with you to obtain an alternate placement.
Approved placements are only valid for one semester. Students will need to submit a request for each semester, even if they intend to work with the same health care system.
Occasionally a preceptor will commit to an experience for a future semester (not the one you are currently seeking placement for). In these instances, complete the Preceptor Request Form and the Clinical Placement Coordinator will hold it on file and submit to the health care agency when appropriate.
All notifications and updates from the Clinical Placement Coordinator and the health care agency will be sent to you via your Marian University email account. Personal email accounts may not be used. Please check DAILY for time-sensitive emails during the approval process!