Preceptor and Facility Agreement

Student IDs begin with 5000xxxxxx or 6000xxxxxx
Some older Student IDs have the format xxx-xxxxxx.
Contact: Lindsey Heaton, 903.565.5569

Preceptor Information


Facility Information

If the facility is already on the approved list, please list it as it appears there.  Also, please do not abbreviate names.
The Contact person IS NOT the preceptor! The Contact person is the representative at the facility who is financially responsible for signing contracts.

A copy of the agreement will be sent to you and to the preceptor at the addresses you provided.

* Indicates Response Required