Are you interested in being a clinical preceptor? * Yes No Students will spend ten weeks in Family Medicine; five weeks at the beginning of the year and five weeks at the end of the year returning to the previous Family Medicine preceptor. This structure allows both the student and preceptor to see improvements and progress in the student’s performance over the year. 2019-2020 rotation dates: June 10, 2019 – July 11, 2019 (Part I) AND May 11, 2020 – June 9, 2020 (Part II) Rotation Availability * I am available for both Part I and II of family medicine I am available for Part I only. Please contact me for additional date options for Part II I am available for Part II only. Please contact me for additional date options for Part I Interested, but unavailable during this clinical year. Keep me on your preceptor list Your Information Name * Practice Name * Office Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Phone * Fax Practice Manager / Contact Person * Email * Hospital Affiliation(s) if the student will be accompanying you during the rotation