Get Cprapplication091505.doc - Utmb

This guide provides a clear and straightforward approach to completing the CPRApplication091505.doc form for Community Preceptor Recognition at the University of Texas Medical Branch. Follow these steps to ensure your application is filled out correctly and submitted on time.

Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to access the CPRApplication091505.doc form and open it in your chosen editor.
2. Begin by filling in your personal information in the Applicant Information section. Provide your last name, first name, degree, mailing address, city, state, zip code, email address, discipline or specialty, and phone number. Ensure all the information is accurate and up-to-date.
3. Review the purpose of the application to confirm that you meet the eligibility criteria. You must have served as a preceptor for at least two full-time UTMB School of Medicine students in the past 12 months, possess a valid medical license in Texas, and have received positive evaluations from each student.
4. Prepare and attach the required documentation, which includes this cover sheet, a summary of your student precepting activities over the past year, and documentation of the continuing medical education (CME) you have completed that focuses on precepting or student education.
5. Double-check all entries and attached documents for completeness. Make sure that your CME documentation includes either a certificate and agenda for educational activities or evidence of completing modules from the EPIC series.
6. After completing the form and attaching necessary documents, follow your editor's instructions to save changes. You may then download, print, or share this completed form as needed for submission.

Ensure your recognition application is filled out accurately and submit it online today.