Clinical Preceptor Recognition Program Application

Welcome and thank you for your interest in the Clinical Preceptor Recognition Program! 
 
Application Requirements:
 
To be eligible for the recognition program, you MUST meet all three requirements.
 
  • Be a current AAPA fellow or sustaining member
  • Have served as a preceptor for at least 8 weeks on average for the last two years
  • Be endorsed by a PA program(s) that you have supported as a preceptor.
 
Instructions:
 
  • Please complete the application below with as much detail as possible
  • Please pass along this endorsement form to the PA program(s) you have precepted for (they can also complete the form in PDF and email/fax to return). 
Precepting History:

Please list the number of students you precepted, the year, total number of weeks during that year and the PA program name. If you precepted for more than one PA Program during the same calendar year, please list as separate line items.
 Number of StudentsYearNumber of WeeksPA Program
1.
2.
3.
4.
5.
PA Program References: 

Please fill in the appropriate information in the fields below.
 PA ProgramContact NameTitlePhoneEmail
1.
2.
3.
4.
Mailing Information:
 
If you are unable to use the online application, please contact AAPA at cp@aapa.org for assistance. You may also print the application, and fax or mail it to AAPA
 
American Academy of Physician Assistants
2318 Mill Rd. Suite 1300
Alexandria, VA 22314
 
P 703-836-2272, Option 1
F 571-519-4313
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