Practice Profile

  • There is a 10MB file size limit. If your CV exceeds this file size, please email to: shenderson13@elon.edu
    Accepted file types: doc, docx, pdf.
  • Availability

  • I am available to take students during the following 6-week timeslots:
  • I am available to take students during the following 3-week timeslots:
  • Please indicate the number of students you can take for each rotation block.
  • We appreciate the flexibility of knowing your full availability for assigning placements. If we need to limit the number of placements, please let us know the number of rotations you can commit to taking students over the year.
  • Is there an honorarium for student experiences? If yes, who is the payee and what is the rate?
  • Please identify the individual designated as Elon PA Program's point of contact for student onboarding (if other than the Preceptor)

    If preceptor, leave blank
  • (Optional) Please provide contact information for the individual who may legally sign the Affiliation Agreement for your facility

  • Student Requirements

  • List the onboarding and training requirements (in addition to what is submitted by Elon) that students will need to complete prior to being on-site.
  • Additional Facilities

    If a student will attend multiple facilities with you, Elon University must have a complete Affiliation Agreement with each facility. Please provide each facility's name and contact person's information so that we are able to meet this requirement prior to the student’s arrival.
  • Enter as many as applicable
  • Thank you!

    We appreciate the opportunity to partner with you in the education of our students!