AHEC Scholars Clinical Training/Rotations

Anticipated Location #4

Select the location (#1-A) where you will do your clinical training. This field will auto-suggest as you begin to type into it. If your location does not appear select 'Location Not Listed' and complete the field below.

If the location (#1-A) of your rotation was not included in the field above please list it below. Please list the location in its entirety.

Example: CHI Health Good Samaritan

If the location (#1-A) of your rotation has multiple sites, please list the location's address or intersection.

Example: 256 Birch St. or Birch and 3rd

If the location (#1-A) of your rotation has multiple sites, please list the location's address or intersection.

Example: 256 Birch St. or Birch and 3rd

List the department where you will do your training (#1-A)

List your start date of your rotation (#1-A)

First day the training started.

List your end date of your rotation (#1-A)

Last day of the training.

List number of rotation days (#1-A)

List the total number of days actively training; e.g., 160 hours over 20 days. The number of days shouldn't necessarily equal the start/end date.

List number of hours completed at this location. (#1-A)

List the total number of hours at this location, e.g., 140 hours

First Name of your preceptor. (#1-A)

If you don't know the first name of your preceptor leave this field blank.

Last Name of your preceptor. (#1-A)

List the profession of your preceptor. (#1-A)

Will your rotation be in primary care? (#1-A) Note: Primary care is the day-to-day health provider that acts as the first point of contact with patients. Examples include non-specialized practitioners in the fields such as family medicine, pediatrician, internal medicine.

Primary Care
Non Primary Care
Unsure

Do you have any additional clinical training/rotations not yet completed, but currently scheduled through July 31, 2023. (Anticipated Location #2-A)

YesNo

Anticipated Location #2

Select the location (#2-A) where you will do your clinical training. This field will auto-suggest as you begin to type into it. If your location does not appear select 'Location Not Listed' and complete the field below.

If the location (#2-A) of your rotation was not included in the field above please list it below. Please list the location in its entirety.

Example: CHI Health Good Samaritan

If the location (#2-A) of your rotation has multiple sites, please list the location's address or intersection.

Example: 256 Birch St. or Birch and 3rd

List the department where you will do your training (#2-A)

List your start date of your rotation (#2-A)

First day the training started.

List your end date of your rotation (#2-A)

Last day of the training.

List number of rotation days (#2-A)

List the total number of days actively training; e.g., 160 hours over 20 days. The number of days shouldn't necessarily equal the start/end date.

List number of hours completed at this location. (#2-A)

List the total number of hours at this location, e.g., 140 hours

First Name of your preceptor. (#2-A)

If you don't know the first name of your preceptor leave this field blank.

Last Name of your preceptor. (#2-A)

List the profession of your preceptor. (#2-A)

Will your rotation be in primary care? (#2-A) Note: Primary care is the day-to-day health provider that acts as the first point of contact with patients. Examples include non-specialized practitioners in the fields such as family medicine, pediatrician, internal medicine.

Primary Care
Non Primary Care
Unsure

AHEC Scholars Clinical Training/Rotations

Anticipated Clinical Training/Rotations. Please list information for one rotation at a time for clinical trainings/rotations you are scheduled for/anticipate completing by July 31, 2021.