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UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY Office of Patient Services (3/3/14) MEMORANDUM TO: Dental preceptor students requesting clinic privileges. FROM: Stephen J. Stefan ac, DDS, MS Associate

How to fill out dental preceptor credentialling form

How to fill out dental preceptor credentialling form:

1. Start by carefully reading the instructions provided with the form. Make sure you understand all the requirements and necessary documents.
2. Provide your personal information accurately, including your full name, contact details, and any professional affiliations or memberships.
3. Fill in your educational background, including the dental school you attended, graduation date, and any postgraduate training or certifications you have obtained.
4. Indicate your current employment status and provide details of your dental practice, if applicable. Include your practice name, address, and contact information.
5. Be prepared to list any previous preceptorships you have participated in. Include the name of the institution or organization, the dates of the preceptorship, and a brief description of your responsibilities.
6. Provide the names and contact information of any references who can vouch for your competence and professionalism as a dental preceptor.
7. Attach any required supporting documents, such as copies of your dental license, continuing education certificates, or letters of recommendation.
8. Review the completed form thoroughly for any errors or omissions before submitting it. Make sure all the information provided is accurate and up to date.

Who needs dental preceptor credentialling form:

1. Dental students or recent graduates who are seeking a preceptorship experience to enhance their clinical skills and knowledge.
2. Dental schools or programs that require documentation of a preceptorship as part of their curriculum or graduation requirements.
3. Dental professionals who want to become preceptors and supervise dental students or new graduates in a clinical setting.

For pdfFiller’s FAQs

What is dental preceptor credentialling form?

The dental preceptor credentialling form is a form used to credential individuals who supervise and mentor dental students.

Who is required to file dental preceptor credentialling form?

Dental preceptors who supervise and mentor dental students are required to file the credentialling form.

How to fill out dental preceptor credentialling form?

The form can be filled out online or in hard copy and must include information about the preceptor's qualifications and experience.

What is the purpose of dental preceptor credentialling form?

The purpose of the form is to ensure that dental preceptors meet certain standards and qualifications to effectively mentor dental students.

What information must be reported on dental preceptor credentialling form?

The form typically requires information about the preceptor's education, training, licensure, and any relevant experience.

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