FSHD 491:
UNDERGRADUATE PRECEPTOR APPLICATION
Eligibility for a preceptorship is based upon the following qualifications:
1. Be in good academic standing with the University of Arizona with at least a 2.0 grade point average prior to
applying for a preceptorship. Please note that some FSHD instructors may require a higher GPA or specific grade
for the class in which you will preceptor.
2. Have at least junior status with completion of a minimum of 9 FCSC/FSHD units.
3. No undergraduate should be a preceptor in more than one course per semester.
4. According to University Guidelines, undergraduates should be granted no more than two (2) semesters of
preceptorship in their major field, with the possibility of an additional semester, contingent upon quality of
classroom performance.
 Students who take more than 6 units of FSHD preceptorship, with approval of FSHD advisors, may apply
these units to thematic minors or elective credit.
 Students in the FSHD pre-major may only apply 3 units of applied skills (491, 492, 494, or 499) taken as
a pre-major in their upper division FSHD supplemental coursework. Additional units must be taken once
accepted to the FSHD major.
Student Name
Local Mailing Address
( )
Local Telephone Number
SID #
City
(
)
Work Telephone Number
State
Zip
(
)
Cell Phone Number
__________________________________ ___________________________________
E-mail Address
Major
Minor
Class Standing
Projected Graduation Date
Cumulative GPA
Semester & Year
1. What do you think a preceptorship will help you learn or accomplish?
2. List your skills and previous leadership experiences that you think will be relevant to a preceptorship.
10/19/15
-23. What questions do you have for your instructor about the preceptor experience?
4. How do you learn best? For example, by yourself, with others, from books or programs, by asking
questions and watching by example, by trial and error, etc. How do you work best?
5. What kinds of things are you most interested in doing or learning as a preceptor?
Course Number: FSHD 491
Section Number:
Semester/Year: _________________
Please submit this completed application to the course instructor by:
Student Signature
10/19/15
Date