2020-2021 Spelman College Health Careers Preceptor Participation Form
This form is requesting your information to serve as a future preceptor in offering shadowing opportunities to Spelman students. Given our response to the COVID-19 Pandemic, we are also pursuing virtual shadowing opportunities. We welcome ideas of how we can partner with you to offer virtual shadowing to our students.

There are two opportunities for you to partner with us in providing shadowing experiences for our students which are detailed below:

Practicum & Internship Course (Spring Semester Only)
        This is a required course for Health Science majors to fulfill 45 shadowing hours in the Spring semester
        (January - May).

Women in Science & Health (WISH) Shadowing Program (Throughout the year based on your availability)
        WISH is a program offered to ALL Spelman students, regardless of major, who are registered with Health
        Careers Program and are seeking shadowing opportunities. Hours fulfilled are based on your availability.

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First Name *
Last Name *
Phone Number *
Email Address *
What is your preferred method of contact for our Office to reach you?
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Are you a Spelman Alumna? *
If yes, please list your class year.
What is your healthcare specialty? (Be specific) *
Practice/Office Name & Address *
Which Shadowing Program are you willing to participate? (Click all that apply) *
Required
How many students are you willing to support for shadowing? *
Please list your available method of shadowing (Check all that apply)
What is your preferred method of communication from students? *
Additional information.
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