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FORM Professional Credential Services, Inc. PO Box 198788 Nashville, TN 372198689Preceptors Affidavit of Internship Hours This form is to be submitted each time an intern completes training at a new
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How to fill out preceptors affidavit of internship

01
To fill out the preceptors affidavit of internship, follow these steps:
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Start by providing your personal information, including your name, contact information, and professional title.
03
Next, provide the name and address of the educational institution or organization where the internship took place.
04
Indicate the dates of the internship, including the start and end date.
05
Specify the number of hours or weeks you spent on the internship.
06
Sign and date the affidavit to confirm the accuracy of the information provided.
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If required, have the affidavit notarized by a licensed notary public.
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Submit the completed and signed affidavit to the relevant authority or organization.
09
Keep a copy of the affidavit for your own records.

Who needs preceptors affidavit of internship?

01
The preceptors affidavit of internship is typically needed by individuals who have completed an internship as part of their educational or professional training.
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This document may be required by educational institutions, accrediting bodies, licensing boards, or employers to verify the completion of an internship program and the training received.
03
Students, interns, medical professionals, and individuals in various fields may need to provide a preceptors affidavit of internship as part of their application process, licensure requirements, or professional credentialing.
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A preceptors affidavit of internship is a formal document that certifies the completion of an internship under the supervision of a qualified preceptor, detailing the intern's progress and skills acquired during the training period.
Typically, interns in fields such as healthcare, education, or other professional training programs are required to file a preceptors affidavit of internship, often completed by their supervising preceptor.
To fill out a preceptors affidavit of internship, the preceptor must provide their details such as name, title, and contact information, along with a description of the intern's activities, competencies gained, and the duration of the internship.
The purpose of the preceptors affidavit of internship is to formally verify that the intern has satisfactorily completed the required internship experience and has met the educational and professional standards set by the relevant licensing or accreditation bodies.
The information that must be reported includes the intern's name, internship start and end dates, a summary of training activities, competencies demonstrated, and the preceptor's signature and credentials.
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