Preceptor : University of Dayton, Ohio

Monetary Stipend Available for Medical Providers

The University of Dayton Physician Assistant Education program is offering a monetary stipend to medical providers who accept and precept UD physician assistant students for a clinical experience. The stipend is proportional to the amount of time the student spends at the assigned clinical site.

For additional information, explore these resources:

Clinical Preceptor Interest Form

Thank you for your interest in becoming a clinical preceptor for the University of Dayton Physician Assistant Education program. Please complete the form below, and the Director of Clinical Education will contact you with additional information. If you have any questions, please contact the UD PA program at 937-229-3281 or email khuesman1@udayton.edu.

First Name

Last Name

Credentials

If answering "Other" to the "Credentials" item above, please describe here:

Email Address

Phone Number (including area code)

Field of Practice

If answering "Surgery" to the "Field of practice" item above, please describe sub-specialty here:

If answering "Other" to the "Field of practice" item above, please describe here:

Are you board certified?

Area of board certification/certification body?

Practice Name

Practice Mailing Address

Type of Practice

If answering "Medical organization owned" to the "Type of practice" item above, please select from the following:

If answering "Other" to the "Medical organization owned" item above, please describe here:

State License

Hospital/Surgical Center Affiliations

Office/Hospital Contact for Preceptor (first name, last name, email and phone)