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Phase 1 Preceptor Program Interest Form

The Phase 1 Preceptor Program (P1PP) is a three-semester longitudinal experience that introduces outpatient clinical care to 1st- and 2nd-year medical students.

"*" indicates required fields

Name*
How many students are currently assigned to you?
(If unsure, leave blank and add comments below)
Are you able to continue working with your current student(s)?
How many new students would you like assigned to you?*
Indicate clinic times available to students. If you are willing to preceptor more than one student, students will be scheduled at different times.
Available Mornings (8 a.m.–noon)
Available Afternoons (1–5 p.m.)
By submitting this form, I understand that my information will be used by WMAA to update their records, and, if needed, to contact me with questions.*