School of Public Health and Health Services | George Washington University

Practicum Application - Preceptor

* indicates a required field.

Preceptor Information

First Name: *

Last Name: *

Title: *

Department:

Highest Degree Earned: * Year of Degree: *

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

Are you an employee of the organization where the practicum will be conducted? (Not a volunteer, for example)*

Yes

Alternate Contact

First Name: *

Last Name: *

Title:

Department:

Phone Number: * Fax Number:

Email Address: *

Confirm Email Address: *

Professional Profile

Please paste a copy of your professional profile/resume here.*

Include years of public health and health related experience and skills gained during eduation, including dates.
Please do not submit URLs.

Primary Professional Areas or Services

Homeless health
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 IT
Health policy
Health promotion
Health regulation
HIV/AIDS

Agreement

I agree to be a preceptor for the student(s), assuming the responsibility for directly supervising the work of the student, including providing regular feedback and direction during the practicum and personally submitting all approvals and evaluations electronically to George Washington University SPHHS. I acknowledge that this responsibility cannot be delegated to anyone else.

If for any reason, I am unable to continue providing this direct supervision for a period longer than a few days, I will notify the School of Public Health Practicum Coordinator, Donna Caruso by email (carusod@gwu.edu) or by telephone at (202) 994-7418.