Integrative Practicum Program

Am I eligible to be a Nursing Student Preceptor?

Yes, if you have:

A minimum of two years full-time or three years of part-time direct care experience (less experience can be approved by leadership).
Current employment as a staff nurse working a minimum of 24 hours per week, a willingness to share your experience and knowledge in providing and coordinating care.
An interest in the professional growth that comes from assisting others into this profession.
An interest in being a secondary/backup preceptor, instead of a primary.

What is the process?

Complete the Preceptor Application Form below.
This form must be completed each year you wish to be a Nursing Student Preceptor.
Upon acceptance, you will be assigned a student for spring term and need to read the LCC Preceptor training information.

Thank You! If you had any difficulty with this form or if you have any other questions about the program please contact:

Aimee Kruger, RN, BSN

Nursing Clinical/ Lab Coordinator

541-463-3234

krugera@lanecc.edu

Jennifer Tavernier, DNP, RN, CCM
Associate Dean/Director of Nursing
Phone: 541-463-5637
Email: tavernierj@lanecc.edu

LCC Preceptor Application Form - Sign up Now!

LCC Preceptor application information can be submitted online using this form.

Please click the Submit button at the end of the form. The information is emailed directly to the Integrative Practicum Coordinator and will not be used for any other purpose.

Your name:

Your email:

Home/Cell phone:

Preferred method of contact

Phone Call

Text

Years of practice:

Other roles (facilitator, meal and break nurse, etc):

Hospital/Agency where employed:

Unit:

Shift

Average hours worked per week:

Have you had a preceptor class?:

You will need to arrange a time to meet with your assigned student to coordinate your schedules.

Do you have PTO planned in April, May, or the first half of June?:

Please check one of the boxes below to indicate if you want to contact the student or would prefer to have the student contact you.

I will meet with my student to establish a schedule, and I give permission to release my contact information.

I will meet with my student to establish a schedule, but prefer to contact my student directly. Please send student name and phone number when that becomes available.

Your faculty liaison will meet with you after March 30th to review your role as a Preceptor.

Other Options

Student Name:

If you know a student you would like to work with, please include that name in this box. Faculty will make that placement, if at all possible.

I am only interested in being a secondary Preceptor

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Am I eligible to be a Nursing Student Preceptor?

Yes, if you have:

What is the process?

LCC Preceptor Application Form - Sign up Now!