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PRECEPTOR PROGRAM
 

PRECEPTORSHIP FORMS

 
CLINICAL PRECEPTOR HOURS VERIFICATION
Name of Preceptor:
Semester:

Year

Course #:

Name of Student:

Specialty/Practice:

Practice Site:

Phone Number of Preceptor:

Certifying Organization:

Total Number of Hours Completed with This Student:

Please PRINT the completed form and fax to Sandra Jorgensen at 216-368-3542.
Sandra Jorgensen
Preceptor Coordinator
Frances Payne Bolton School of Nursing
216-368-3198
FAX: 216-368-3542
Office: 304B
 
 
  Preceptor Program | 10900 Euclid Avenue | Cleveland, Ohio 44106-4904 | Phone: 216.368.3198
Part of: Bolton School of Nursing
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