Please provide the following information about your current practice:
Please identify the individual designated as the point of contact (if other than preceptor)
If students will participate with you beyond your primary facility/clinical site, we must have a complete affiliation agreement for each facility. Please provide the following information so we may confirm an existing or gain affiliation prior to students beginning their rotation with you.
Interested in other opportunities such as teaching, serving as a guest lecturer, participating in simulation/skill labs, interviewing applicants, serving as a PBL tutor or have a question/comment?
Please specify in the comment section below:
By submitting this form, I agree to serve as a clinical preceptor for The Kansas State University physician assistant studies program.