WOC Nursing Preceptor Application - Cleveland Clinic
Anonymous Login Code:
Save this code, which is required to update your response at a later time.
Page 1 of 1
Save a copy
Please print a copy of this application for your records PRIOR to submitting. To contact us directly, please call (216) 444-5966 or email to WOCSchool@ccf.org
Please enter the following information:
Enter Information Here
WOC program graduated from
WOC certification exp. date
Please enter your contact information
Enter information here:
Name of business
employed full or part-time?
What is the name of the student you will be precepting?
Would you like to be included in our preceptor data base to precept future students?
Please describe the facility you are working in (e.g. acute care/home care/ambulatory)
Please describe your previous teaching experience.
Please describe any previous precepting experience you have.
Have you ever attended a preceptor workshop?
Have you precepted a student from our program prior to this class? If so, please provide the student name and the date(s) precepted:
Please complete and remit to us our "Preceptor Clinical Stats Form" which describes your WOC practice and includes your patient population and average census. This form will pop up for your completion after you click on the "submit" (done) button to this application. You may print and complete this form later.
NOTE: Prior to the student starting clinicals at your site, a proposed clinical schedule (evidencing the number of clinical hours per day) must be submitted to the school. Fax to 216-445-6343 or scan/email to WOCschool@ccf.org.
Please copy/paste your CV or resume into this text box
A clinical contract between your agency and the Cleveland Clinic must be completed prior to the student beginning class. The student has a template of a contract designed specifically for our WOC nursing education program. If you have any specific questions, please enter here. Please print a copy of this application for your records PRIOR to submitting.