FORMS
Preceptor-Site
Information Form
If you did
not receive this form in the mail or from your student, you may download and print it.
Mail, fax, or scan and attach to an e-mail, along with your CV, to the Clinical
Resource Associate. We require this information for our continuing
accreditation.
Evaluations:
The student should give you the evaluation forms. You may
also download them:
Evaluation Form —
Mid-Rotation
Evaluation Form
—
End of Rotation
Mail, Fax, or scan and attach to an e-mail.
Send to:
Barbara Williams,
Clinical Resource Associate
Jefferson
College of Health Sciences
Physician Assistant Program
PO Box 13186
Roanoke, VA 24031-3186
Phone: 540-224-4538
Fax: 540-224-4551
Preceptor-Site
Affiliation Agreement
Two hard copies of this document, signed by our Program Director
and the President of the College, will be included in your initial packet for your approval.
Please sign and return one copy to us.
Carilion Event Form
The student must use
this form if he or
she needs to report an accident, exposure to hazardous
substance, or communicable disease.
Some of these forms are in pdf
format. To
read and print them, you need Adobe Acrobat Reader. To
download the Reader free, click on the logo and follow the instructions. |
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Copyright © 2007 Physician Assistant Program, Jefferson College
of Health Sciences.