MSN FNP Preceptor Intent Submission
Anonymous Login Code:
Code Entry Page
Save this code which is required to update your response at a later time.
Student and Term Information
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What is your first and last name?
What is your Student ID number (starts with 850)?
What course number is this information for?
(NSGL 520 = Pediatric Health; NSGL 521 = Women's Health; NSGL 522 = Adult Primary
Care I; NSGL 594 = Family Health Primary Care)
NSGL 520 Pediatric Health
NSGL 521 Women's Health
NSGL 522 Adult Health: Primary Care I
NSGL 594 Family Health: Primary Care II
What term will you be completing this rotation?
Fall 2020: August 19, 2020 - December 2, 2020
Spring 2021: January 11, 2021 - April 28, 2021
Fall 2021: Dates not yet released
What is your preceptor's first name?
Preceptor's middle initial/name
What is your preceptor's last name?
What are your preceptor's credentials?
Students are required to have at least one NP as a preceptor during the MSN FNP program.
Other, please specify
Agency Contact full name and title:
This is either a practice manager, executive assistant, secretary, etc. that communicates
information directly to your preceptor. If you have provided direct contact information
for your preceptor, this can be skipped.
This is extremely important as we will communicate paperwork, rotation requirements,
and so on directly with your preceptor or their contact person via email. If you would like
to provide multiple emails, please separate emails with a semicolon(;).
Agency Phone Number:
Agency Full Name:
Street address 2:
Which AHEC region does this rotation fall in?
This depends on the county the rotation is taking place in. Please use this link to assist you
Area L AHEC
South East AHEC
Southern Regional AHEC
Please fill in your preceptor's RN or medical license number.
How many total hours do you plan to complete with this preceptor
within this term?
If you are going to have multiple preceptors within the same semester, please SUBMIT A NEW
SURVEY for that preceptor and allot the hours accordingly.
Are you currently employed by this agency?
Is this site you are submitting a part of Atrium Health?
If you select
, there are fees and
associated with being placed
at an Atrium Health site. Starting in the SPRING 2019 semester, students that select an Atrium
Health site to do their rotation
will be required to pay
the associated fees.
*If you are unsure if your site is an Atrium site, visit their
their Locations tab to search your site.
If you would like your results emailed to you, please provide your UNCW email below using
the @uncw.edu (i.e.