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Thursday, May 25, 2017   1:39 AM    |   71°F

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Graduate Preceptor Credentialing

*First Name:  
Middle:
  *Last Name:  
*Credentials:  
*Position/Title:
 
*Certification Type: (i.e. M.D.,FNP,CNS,CNM)  
*Name of Certifying Board:
 
*College or University:
 
*Degree:  
*Date Completed:
 
*Clinical Facility Name:
 
Mailing Address:
 
City:
  State:   Zip:  
*Phone Number w/Area Code:    
*Email:
 
*Population Focus:  
*Years of Practice in Area:
 
*Number of students precepting concurrently:  
*CV/Resume:  

I, * (preceptor's name), agree to act as preceptor for a Nursing Graduate Student at LSUHSC, School of Nursing and assist the student to achieve the course outcomes for the course.



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