NURSE PRACTITIONER CLINICAL PRECEPTORSHIP APPLICATION

Application Components:

Completion of this Application Form
Curriculum Vitae or Resume
One-Page Statement of Interest in Nurse Practitioner Clinical Preceptorship at DAP Health
Syllabus for the Course
Forms and required documents can be emailed to David Lee, BSN, RN at
dlee@daphealth.org
Please send application and required documentation at least 3 months prior to anticipated start of your clinical preceptorship.

NURSE PRACTITIONER CLINICAL PRECEPTORSHIP APPLICATION

Legal Name(Required)

First Last

Chosen Name(Required)

First Last

Pronouns(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

NP Program Information

University Name(Required)

Focal Area (FNP, AGPCNP, etc.)(Required)

Clinical Course(Required)

Number of Hours Requested(Required)

Number of Weeks to Complete the Hours

Curriculum Vitae or Resume(Required)

Max. file size: 80 MB.

Statement of Interest Instructions

• One page, 1-inch margin. • Times New Roman, 12 font, double spaced. • Describe why you are interested in having your clinical preceptorship at Desert AIDS Project. Describe academic/professional goals you would like to accomplish in this clinical preceptorship.

Statement of Interest(Required)

Max. file size: 80 MB.

Call: (760) 323-2118

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