Preceptorship Request Form
Need a Preceptor?
Prospective Students requesting preceptorships.
Sivam Diabetes & Primary Care LLC serves as a clinical site for many healthcare professionals. Space is limited, but we will do our best. If you would like to be considered for placement to complete NP, Dietetics Internships or other Allied Health hours, forward the following information to sivam.diabetes.llc@gmail.com
- Full Name: _______________________________________________________
- School Name: _____________________________________________________
- Program: _________________________________________________________
- Name of Supervising Faculty: ________________________________________
- Clinical hours required: _____________________________________________
- Start/End Dates: ___________________________________________________
- Resume/CV: _____________________________________________________
Our student coordinator will contact you. We look forward to enhancing your clinical practice experience.
