She made me feel comfortable. She didn't sit behind a desk - she sat down with me and talked to me face to face MORE>>

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Preceptor Inquiry Form

Stark Learning Center - Room 336 • 570-408-4267 (T) ) • Email

Preceptor Inquiry Form

Preceptor Inquiry Form

Please complete the form below if you are interested in becoming a preceptor.

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First Name*
Last Name*
Position*
Place of Employment/Potential Site Name*
Address of Site*
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Office Phone* - (###) - ### ####
Office Email *
When would you begin to be able to accept students?* MM/DD/YYYY
Please tell me why you would like to become a preceptor*
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