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Which the Residency occurs Has exceeded requirement Has met requirement Has not met requirement Comments II. PRECEPTOR RESIDENCY FORM SCHOOL OF HEALTH ADMINISTRATION Faculty of Health Professions Dalhousie University 5161 George Street Suite 700 PO Box 15000 Halifax NS B3H 4R2 Phone 902 494-7097 Fax 902 494-6849 Note Forms can be downloaded in Word format at dal.ca/sha Preceptor/Resident Evaluation Form Student Name Agency/Organization Preceptor Name and Title Purpose The intent of this...
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How to fill out preceptor residency form
How to fill out preceptor residency form
01
Read the instructions carefully before filling out the form.
02
Provide accurate personal information such as name, contact details, and address.
03
Include your educational background, including the name of the institution and the degree earned.
04
Specify the duration of your residency and the period of the preceptorship.
05
Provide details about the preceptor you worked with, such as their name, credentials, and contact information.
06
Write a concise summary of your activities during the preceptorship, highlighting the skills and knowledge gained.
07
Attach any supporting documents or certificates related to your residency.
08
Proofread the form for any errors or omissions before submitting it.
09
Submit the completed form to the relevant authority or institution within the specified deadline.
Who needs preceptor residency form?
01
Students or professionals who have undergone a preceptor residency program.
02
Individuals seeking to fulfill residency requirements for specific professions, such as medical, nursing, or pharmacy residencies.
03
Applicants for further studies or employment opportunities that require documentation of a preceptorship experience.
04
Those who need to provide evidence of practical training and hands-on experience under the supervision of a preceptor.
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What is preceptor residency form?
The preceptor residency form is a document that is used to verify the residency status of preceptors.
Who is required to file preceptor residency form?
Preceptors who are supervising residents in a residency program are required to file the preceptor residency form.
How to fill out preceptor residency form?
Preceptors can fill out the preceptor residency form by providing their personal information, residency status, and signature.
What is the purpose of preceptor residency form?
The purpose of the preceptor residency form is to ensure that preceptors meet the residency requirements for supervising residents in a residency program.
What information must be reported on preceptor residency form?
The preceptor residency form must include the preceptor's personal information, residency status, and signature.
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