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Midwifery Preceptor Reference Form
Please complete the form below to provide a reference for the applicant who has applied to become a midwifery clinical preceptor in the Midwifery Education Program. Note this form does not have a save function. In order to to submit your responses to the MEP, select "Submit" at the bottom of this form. If you exit before selecting Submit, your answers will not be saved.
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Email
*
Your email
Name of applicant
Your answer
Your name
Your answer
Email address
Your answer
Phone number
Your answer
Position/occupation
Your answer
Relationship to applicant
Your answer
How long have you known the applicant
Choose
Less than 1 year
1-2 years
3-5 years
More than 5 years
Please comment on the applicant’s suitability for being a clinical teacher for students in the Midwifery Education Program.
Your answer
Place your initials below to represent your signature
Your answer
Date
MM
/
DD
/
YYYY
Thank you
Thank you for your reference letter.
Vicki Van Wagner, Clinical Education Coordinator
Loreto Freire, Experiential Learning Coordinator (GTA)
Martha Sharpe, Placement Coordinator (GOA)
Midwifery Education Program, Toronto Metropolitan University
A copy of your responses will be emailed to the address you provided.
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