NCE’s 2023-2024 fiscal year, illustrating how the College is following through with our commitment to the betterment of education on both a local and national level.
Letter of Intent
☐ I would like to be a preceptor for the Physician Assistant Program starting in September of 2027. ☐ I would like to be on the Physician Assistant Program’s Advisory Board. ☐ I would like to be a clinical instructor/academic adjunct faculty for the Physician Assistant Program.
SCPE to Precept
Number of Clinical Rotations per Year
Family Medicine Internal Medicine Pediatrics Surgery Emergency Medicine Behavioral Health Women’s Health Elective:
Preceptor Information
Preceptor Name
Preceptor Phone Number
Preceptor Email Address
Practice Location Name
Practice Location Address
Practice Location Phone Number
Practice Location Fax Number
Please email this completed form to Dr. Robert Hill (rhill25@nl.edu) or Mr. Ryan Atkins (ratkins3@nl.edu).
The National Lous University (NLU) Physician Assistant Program will apply for Accreditation - Provisional from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The NLU Physician Assistant Program anticipates matriculating its first class in September of 2027, pending achievement of Accreditation - Provisional status at the June of 2027 ARC-PA meeting. Accreditation - Provisional is an accreditation status granted when the plans and resource allocation, if fully implemented as planned, of a proposed program that has not yet enrolled students appear to demonstrate the program’s ability to meet the ARC- PA Standards or when a program holding accreditation-provisional status appears to demonstrate continued progress in complying with the Standards as it prepares for the graduation of the first class (cohort) of students.
PA Faculty/Director of Clinical Education Signature:
Date Received:
PRECEPTOR APPLICATION
PLEASE TYPE OR PRINT CLEARLY
SECTION A
Preceptor Name :
(Last)
(First)
(MI)
(Suffix)
(Degree)
Advanced Practice Provider’s Collaborating Physician :
Facility/Practice Name:
Preceptor Mailing Address:
(Street)
(City)
(State)
(Zip Code)
(County)
Phone Number:
Fax Number:
Email Address:
Office Manager Name:
Office Manager Phone Number:
Office Manager Email Address:
☐ I have included a copy of my CV, state licensure, and board certification with this application ☐ I will email a copy of my CV, state licensure, and board certification ASAP SECTION B Practice Type – Please check all that apply (B3.0 1) ☐ Hospital Clinic ☐ Non - Profit Health Clinic ☐ Private Group Practice ☐ Public Health Clinic ☐ Rural Health Clinic ☐ Private Solo Practice ☐ Surgery Center/OR ☐ Hospital/Health System ☐ Telehealth ☐ Military ☐ Inpatient ☐ Outpatient
Practice Specialty – Please check all that apply (B3.06) ☐ Family Medicine ☐
Emergency Medicine Behavioral Health
☐ Internal Medicine
☐ ☐ ☐
☐ Pediatrics ☐ Surgery
Women’s Health
Elective:
Please email this completed form to Dr. Robert Hill (rhill25@nl.edu) or Mr. Ryan Atkins (ratkins3@nl.edu).
The National Lous University (NLU) Physician Assistant Program will apply for Accreditation - Provisional from the Accreditation Review Commission on Education for the Physician Assistant (ARC - PA). The NLU Physician Assistant Program anticipates matriculating its first class in September of 2027, pending achievement of Accreditation - Provisional status at the June of 2027 ARC - PA meeting. Accreditation - Provisional is an accreditation status granted when the plans and resource allocation, if fully implemented as planned, of a proposed program that has not yet enrolled students appear to demonstrate the program’s ability to meet the ARC - PA Standards or when a program holding accreditation - provisional status appears to demonstrate continued progress in complying with the Standards as it prepares for the graduation of the first class (cohort) of students.
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