Preceptorship Online Application 2007-2008

-All fields are required-

Name
Email
UO ID

Phone
Address

Year in School
Major

Preceptorship Term(s) Desired:
	Spring 2008
Please list three preferred physician specialties (i.e. pediatrics, geriatrics, ophthalmology, family medicine, etc.):
Choice 1
Choice 2
Choice 3

Brief Questions:
	1. For what reason(s) are you interested in becoming a medical doctor?
	2. What benefits do you plan on receiving from the Preceptorship program?
	3. Please provide any questions or concerns you have in regards to participating in this program. No matter what questions/concerns you have, they will not jeopardize your chances of receiving a Preceptorship.

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