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Practicum Application - Preceptor

* indicates a required field.

Preceptor Information

First Name: *

Last Name: *

Title: *

Department:

Highest Degree Earned: * Field (If necessary):

Years of Public Health experience: * Certifications:

Phone Number: * Fax Number:

Email Address: *

Confirm Email Address: *

I am a GW graduate.

Department/Track Preference: *

Do you have a limited service faculty appointment at GWU?

Yes

Have you previously served as an SPHHS Site Preceptor?

Yes

Alternate Contact

First Name: *

Last Name: *

Title:

Department:

Phone Number: * Fax Number:

Email Address: *

Confirm Email Address: *

Biosketch / Resume

Please paste a copy of your one page biosketch here.*

Primary Professional Areas or Services

Hygiene and sanitation
Immigrant and refugee health
Immunizations
Infant mortality
Infectious diseases
Injury/injury prevention
Interventions (e.g. design, delivery)
Long-term care
Maternal health
Medicare/Medicaid
Mental health
Minority health
Nutrition
Obesity
Occupational health
Physical activity and exercise
Population health
Referral for health services
Reproductive/perinatal health
School health
Sexually transmitted diseases/infections
Social services
Substance use/alcoholism
Surveillance (e.g. disease)
Tobacco Control
Tuberculosis
Violence/violence prevention
Workforce development
Women's health

Aging and senior services
Adolescent health
Asthma
Bioterrorism
Cancer
Cardiovascular health
Child health (pre-adolescent)
Chronic diseases
Community health
Community organizing
Dental health
Diabetes
Emergency preparedness
Environmental health
Epidemiological investigation
Evaluation (e.g. interventions, health services)
Family health
Family planning
Family violence
Gay, lesbian, and transgender health
Global health
Health communications/marketing
Health disparities
Health education/outreach
Health finance
Health policy
Health promotion
Health regulation
HIV/AIDS
Homeless health

site maintained by James Kraetz | last updated 17 May 2008 | Site Map