Get the free Additional Preceptor Signature Form - birthingwayedu

Additional Preceptor Signature Form Please use this form to get the signatures of additional CoP receptors you are working with for Clinical Training Credits. If you have any questions, please contact

How to fill out additional preceptor signature form

How to fill out additional preceptor signature form?

1. Obtain the additional preceptor signature form from the appropriate authority or department.
2. Fill in your personal information such as your name, student ID number, and contact details on the designated fields.
3. Provide the details of your primary preceptor, including their name, job title, and contact information.
4. Indicate the duration of your preceptorship or the specific dates during which the form is applicable.
5. Clearly state the objectives or goals of your preceptorship that you aim to achieve.
6. Specify the activities or tasks that you will be undertaking under the supervision of your additional preceptor.
7. Obtain the signature of your primary preceptor, acknowledging and agreeing to your request for an additional preceptor.
8. Similarly, acquire the signature of your additional preceptor, indicating their acceptance of the responsibility to co-supervise your preceptorship.
9. Submit the fully filled and signed form to the appropriate authority or department, as per their instructions.

Who needs additional preceptor signature form?

Students who require a different or additional preceptor to oversee their preceptorship or clinical experience need to fill out an additional preceptor signature form. This could typically apply to situations where the chosen preceptor is not available for the entire duration of the preceptorship, or when the student seeks specialized knowledge or experience in a specific area that their primary preceptor might not possess. The additional preceptor signature form ensures that both preceptors are aware of their roles and responsibilities in supervising the student's learning experience.

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What is additional preceptor signature form?

The additional preceptor signature form is a document used to verify that a student has completed their required preceptorship hours under the supervision of an additional preceptor.

Who is required to file additional preceptor signature form?

Students who have completed their preceptorship hours under the supervision of an additional preceptor are required to file the additional preceptor signature form.

How to fill out additional preceptor signature form?

The additional preceptor signature form should be completed by the student, the original preceptor, and the additional preceptor. It should include details of the hours completed, tasks undertaken, and any feedback or comments.

What is the purpose of additional preceptor signature form?

The purpose of the additional preceptor signature form is to document and verify that a student has fulfilled their preceptorship requirements under the supervision of an additional preceptor.

What information must be reported on additional preceptor signature form?

The additional preceptor signature form should include the student's name, the original preceptor's name, the additional preceptor's name, the dates and hours of preceptorship, tasks completed, and any additional comments or feedback.