Jump to navigation
Jump to content
Explore UAB
MyUAB
BlazerNet
Canvas
Email
Future Students
Visit UAB
opens a new website
Apply to UAB
opens a new website
Request Info
opens a new website
Undergraduate Students
Advising
opens a new website
Undergraduate Catalog
opens a new website
Request Info
opens a new website
Research and Service Learning
opens a new website
Graduate Students
Graduate School
opens a new website
Graduate Catalog
opens a new website
Online Degrees
opens a new website
Parents & Family
Services
opens a new website
Resources
opens a new website
Family Visits
opens a new website
Alumni
Get Involved
opens a new website
Benefits
opens a new website
Events
opens a new website
Faculty & Staff
Office of Provost
opens a new website
Faculty Resources
opens a new website
Staff Council
opens a new website
Researchers
Office of Research
opens a new website
Harbert Institute
opens a new website
CCTS
opens a new website
Patients
UAB Medicine
opens a new website
UAB Dentistry
opens a new website
UAB Optometry
opens a new website
Athletics
Campus Map
Give
Calendar
News
Contact Us
Colleges & Schools
Arts
&
Sciences
Collat School
of Business
Dentistry
Education
Engineering
Graduate School
Health Professions
Honors College
Medicine
Nursing
Optometry
Public Health
Explore UAB
School of Nursing
Give
Apply
SON Gear
Directory
Search
This Site
All Sites
Search
Search
Home
About
Academics
Overview
Undergraduate Programs
Master's Programs
Doctoral Programs
Post-Graduate Options
Discover Our Programs
Continuing Education
Student Resources
Preceptor Information
Office of Student Success
Diversity
Research
Practice
Global
Technology & Innovation
Overview
Innovative & Experiential Learning
Clinical Skills Videos
Health Network
eLearning
Continuing Education
Special Initiatives
Alumni
News
Opens an external link.
School of Nursing
Close
Give
Apply
SON Gear
Directory
Home
About
Academics
Overview
Undergraduate Programs
Master's Programs
Doctoral Programs
Post-Graduate Options
Discover Our Programs
Continuing Education
Student Resources
Preceptor Information
Office of Student Success
Diversity
Research
Practice
Global
Technology & Innovation
Overview
Innovative & Experiential Learning
Clinical Skills Videos
Health Network
eLearning
Continuing Education
Special Initiatives
Alumni
News
Opens an external link.
Nursing
Academics
Preceptor
Preceptor Information Form
Preceptor
Preceptor Information Form
UAB School of Nursing Preceptor Information Form
First Name
(*)
Please let us know your name.
Last Name
(*)
Please let us know your name.
Middle Name
Please let us know your name.
Home Address
(*)
Invalid Input
City
(*)
Invalid Input
State
(*)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Deleware
Dist of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Lousiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Invalid Input
Phone Number
(*)
Invalid Input
Email
(*)
Please let us know your email address.
Discipline
(*)
DO
MD
NP
Other
Invalid Input
State License Number
(*)
Please write a subject for your message.
DO or MD Certification
Invalid Input
Nurse Practitioner Certification
AACN
AANP
ANCC
NCC
PNCB
Invalid Input
Nurse Midwifery Certification
AMCB
Invalid Input
Current Practice Site
(*)
Invalid Input
Current Area of Practice
(*)
Adult-Gerontology Acute Care
Adult-Gerontology Primary Care
Care Transitions
Family
Neonatal
Nurse Educator
Nurse Executive
Nursing Health Systems Administration
Nursing Informatics
Nurse Midwifery
Pediatric Acute Care
Pediatric Primary Care
Population Health
Psych/Mental Health
Women's Health
Invalid Input
Other
Invalid Input
(*)
Invalid Input
Submit
