Physician Assistant Student Preceptor Application

Important Considerations:

The practice's participation in the preceptorship program is contingent upon the university providing a stipend, which helps support the valuable educational experience we offer to the students..

Acceptance into the preceptorship program is contingent upon meeting the practice's requirements and availability..

RDV Sportsplex Pediatrics reserves the right to decline applications that do not meet the stated criteria.

Full Name

PA Program and University

Anticipated Graduation Date

Date

Phone

Email

example@example.com

Desired Rotation Start Date

Date

Desired Rotation End Date

Date

Number of Weeks Requested

Preferred Days of the Week for Rotation

Number of Hours per Week Available for Rotation

Specific Areas of Interest within Pediatrics

Please provide a brief statement outlining your goals for this clinical rotation and what you hope to gain from the experience at RDV Sportsplex Pediatrics

Please list any previous clinical experiences or relevant coursework that hasprepared you for this rotation:

Please submit this completed application, along with your CV/resume and a letter of recommendation from your PA program, to EliseB@rdvpediatrics.com

Disclaimer: The information provided in this application will be used to assess your suitability for a preceptorship at RDV Sportsplex Pediatrics.