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SUMMER PRECEPTORSHIP
APPLICATION PROCESS
Please provide the following information:
Name:
Address:
Phone Number:
UWL e-mail:
Academic Advisor: Select Advisor
List the courses you are currently enrolled in.
List the courses you will take the Spring Semester before your preceptorship.
Identify your potential Preceptorship site.
Please attach a detailed rationale/reason(s) for your request to participate in the Preceptorship during
the summer. Make sure you provide all the specifics regarding your request, keeping in mind a
maximum of eight students will be enrolled. Be certain to provided evidence (example – graduate
school correspondence).