Get Osbn Preceptor Agreement Sample

Filling out the OSBN Preceptor Agreement Sample online is a critical step for ensuring that advanced practice students receive appropriate clinical supervision in Oregon. This guide provides clear instructions to help users understand each component of the form and complete it efficiently.

Follow the steps to fill out the form accurately.

1. Use the 'Get Form' button to acquire the Preceptor Agreement sample and open it in your preferred document editor.
2. Begin by entering the program, college, or university name in the designated field. This identifies the institution responsible for the student’s clinical experience.
3. Next, fill in the student's name in the appropriate section to ensure they are correctly identified on the agreement.
4. Specify the degree sought by the student, such as MSN - FNP, to indicate the educational goals of the clinical experience.
5. Provide information about the clinical agency or facility. Enter the agency/facility name, along with the street address, city, state, and zip code, ensuring accurate contact details are supplied.
6. Input the name and position of the contact person at the agency or facility who will oversee the clinical experience. This may include their phone number for direct communication.
7. In the assigned faculty section, enter the faculty member's name, specialty, Oregon APRN license number, and contact email. This identifies the supervising faculty responsible for the student.
8. The clinical preceptor must affirm their commitment by typing or printing their name in the designated space. They should also indicate their Oregon license number and population focus/specialty area.
9. Both the clinical preceptor and faculty must provide electronic signatures or indicate that signatures are on file with the nursing program. Ensure that each signature is appropriately placed and dated.
10. Finally, review all entered information for accuracy, make any necessary corrections, and proceed to save your changes. You can also download, print, or share the form as needed.

Complete your OSBN Preceptor Agreement Sample online today to ensure timely submission to the Oregon State Board of Nursing.