Returning Le Moyne PA Preceptor Form for 2024-25 Clinical Year

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Thank you for your interest in continuing to serve as a preceptor for Le Moyne College PA students. This form is for returning preceptors. If you are a new preceptor or at a new site that we do not currently have an affiliation agreement with, please complete the new preceptor form available on our preceptor website. Not sure or have questions? Contact Katie Compagni at compagkh@lemoyne.edu or Al Placeres at placeral@lemoyne.edu

Email *

Preceptor Name (with credentials: MD, DO, NP, PA, CNM) *

Practice Setting *

Practice Name *

Office Contact Name *

Office Contact Email *

Please indicate when your schedule allows for precepting a PA student. *

Rotation 1: 8/26/24 - 9/26/24 (5 weeks)

Rotation 2: 9/30 - 10/31/24 (5 weeks)

Rotation 3: 11/4/24 - 12/5/24 (5 weeks)

Rotation 4: 1/6/25 - 2/6/25 (5 weeks)

Rotation 5: 2/10/25 - 3/13/25 (5 weeks)

Rotation 6: 3/17/25 - 4/17/25 (5 weeks)

Rotation 7: 4/28/25 - 5/29/25 (5 weeks)

Rotation 8: 6/2/25 - 7/3/25 (5 weeks)

Rotation 9: 7/14/25 - 8/7/25 (4 weeks)

I am interested in precepting students but cannot commit to specific dates at this time

I am unable to precept students this clinical year, but please keep me in mind for the future

Required

If you are willing to precept more than one student per rotation selected, please indicate the rotation number and the number of students here.

Total number and/or capacity of PA students you will precept during the 2024-25 clinical year:
*

Do you have a colleague who is interested in precepting a PA student? If yes, kindly provide their name, specialty area, practice name, and email address here and we will contact them directly, or encourage them to submit a new preceptor form here.

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