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.

Download DNP-FNP Agreement Form
Download DNP Leadership Agreement Form

Request due dates

  • Spring I: October 1st
  • Spring II: December 1st
  • Summer 1: Feb1st
  • Summer II: April 1st
  • Fall I: June 1st
  • Fall II: August 1st

**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

Student Name:*
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Program Track:*
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Preceptor

Name of Preceptor:*
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Preceptor's Phone #:*
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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.

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Primary Phone #:*
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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.

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If an affiliation agreement has not been established please complete this form and notify the Graduate Clinical Coordinator at graduateclinicals@holyfamily.edu.

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