EMS Preceptors
- Online Preceptor Acknowledgment

Online Preceptor Acknowledgment

Preceptor Training

Please make sure all boxes are filled out before clicking on the Submit button below.

All form fields with * are required.

* First Name:

* Last Name:

*Address:

* City:

State/ZIP Required:

Zip:

Phone Number:

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* Agency Affiliation:

* Supervisors Name:

* Level of Training:

* E-mail:

* Confirm E-mail:

Check off the date for which you will be submitting your online Preceptor Training:

Date of Training

All Preceptors MUST read the paragraph below.

I acknowledge that by submitting this information that it is true and accurate and I have completed the on-line Preceptor Power Point Presentation and have reviewed the Clinical Preceptor Guidelines Manual for St. John's University (STJ) Emergency Medical Services Institute.

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