Get Clinical Instructor Profile. In Lieu Of Va Form 10-0105b

This guide provides clear instructions on how to complete the Clinical Instructor Profile form, which is designed for VA instructors and their counterparts from affiliated schools. Following these steps will ensure accurate and efficient completion of the form.

Follow the steps to successfully complete the Clinical Instructor Profile form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin by filling in the 'VA Facility' section. Clearly enter the name of the VA facility where you serve as an instructor.
3. Next, in the 'Program' section, specify the program you are involved with at the VA facility.
4. In the 'Affiliating Institution' section, provide the name of the institution with which you are affiliated for your teaching role.
5. For the 'Instructor' field, list your full name as it appears on official documents. In the 'Present Positions' field, describe your current role, including any relevant titles.
6. Fill in the 'Registration/Licensure' section by indicating your state, licensure date, expiration date, and your license number.
7. In the 'Educational Profile' part, provide details of the institution, program, degree, and year awarded for each educational achievement.
8. For 'Advanced Educational Preparation for Last 2 Years', list courses and continuing education activities you have completed.
9. In the 'Publications Limited to Last 2 Years' section, include any relevant publications you have authored as part of your doctoral program.
10. For the 'Professional Experience' section, outline your professional roles for the last five years. Include the dates, position titles, and places of employment for clarity.
11. Once all sections are complete, review your entries for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your Clinical Instructor Profile form online today for a streamlined submission process.