BUCOM Preceptor Application

Thank you for your interest in a preceptor position with Baptist Health Sciences University College of Osteopathic Medicine (Proposed).  Please fill out and submit the form below and attach your current CV.  If you do not have a CV, you may fill out the abbreviated CV form (link).  After verification of your credentials, the Senior Associate Dean for Clinical Affairs will review your application.  If approved, you will receive an appointment letter and the BUCOM preceptor handbook.
 

Personal Information

address
Degree (DO vs MD)

Certifying body: (AOA vs ABMS)

Medical Licenses

State of Medical Licenses:
State of Medical Licenses:
State of Medical Licenses:


Curriculum Vitae (CV)

Attach current CV or fill out abbreviated CV form

Abbreviated CV form

One file only.
128 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.