Forms

Students

• Out-of-Program Rotation Request Form
• Special Studies Form (PHMY 539, PHEX 509, & PHEX 559)
• Preceptor of the Year Nomination Form

Forms for Rotations

• Food and Drug Administration
         Declaration for Federal Employment
         E-QIP Initiation Form
         Volunteer Program for Students Form
  
• Giant
         Confidentiality Statement
  
• Kaiser Permanente
         Student Profile
         Health Attestation
  
• Washington County Hospital
         Confidentiality Agreement
         Immunizations
         Liability Waiver
         Student Request Form

New Preceptors

To become a preceptor, please complete an application, an affiliation agreement, and a site information survey. Please contact the ELP office to verify if an affiliation agreement and site survey are already in place.

• Preceptor Application
• Standard Affiliation Agreement
• Institutional Site Information Survey
• Community/Other Site Information Survey