Graduate Preceptor Site

Welcome to the Graduate Nursing Preceptor Request Site. This has been established to help facilitate all of your preceptor requests in a timely and efficient manner. It is very important to comply with the below due dates and requirements. This form must be completed prior to submission. A copy of your preceptor’s resume, board certification, license, and a signed preceptor agreement form are required. Please upload these documents below.

Request due dates

  • Spring I: October 1
  • Spring II: December 1
  • Summer 1: Feb 1
  • Summer II: April 1
  • Fall I: June 1
  • Fall II: August 1

**If your practicum agency is not currently on our affiliation agreement list you must submit your request at least 120 days prior to the clinical start date in order to process a new affiliation agreement request.

Demographics

Program Track:

Preceptor

(eg. MD, OD, NP)
(e.g., family practice, pediatric, gerontology)
(Optional)

Affiliation

Affiliation agreements are required between Holy Family University and all agencies. A practicum site may fall under a larger health care institution/agency. Please verify with your preceptor if their office is associated with a larger healthcare institution/agency (i.e. Jefferson Health, Temple University). A list of our current affiliation agreements can be found below. This is separate from the preceptor agreement form.

View the List of Affiliation Agreements for the DNP Program

**If your practicum agency is not currently on our affiliation agreements list you must submit your request at least 120 days prior to the clinical start date in order to process a new affiliation agreement request.

(if different from your preceptor)
Office Address:

Attachments

Please upload the following documents for your preceptor. Your uploaded files may not exceed 3MB in size and must have a file format ending in .pdf, .doc, or .docx.

Note: All documents are required prior to submission.

(MD, DO, NP)
One file only.
100 MB limit.
Allowed types: pdf, doc, docx, .

One file only.
100 MB limit.
Allowed types: pdf, doc, docx, .
One file only.
100 MB limit.
Allowed types: pdf, doc, docx, .
(optional)
One file only.
100 MB limit.
Allowed types: pdf, doc, docx, .