Practical Immersion Experience (PIE) Preceptor Sign Up

Please complete this form to express your interest in signing up for PIE for the MD Class of 2026. July 5 - August 11, 2023.

First Name *

Last Name *

Email *

What is your specialty? *

Are you a Rural and Urban Underserved Program (RUUP) preceptor? *

Do you consider yourself bilingual in Spanish? *

What is the legal name of your clinic and/or location? *

How many students would you like to work with for this experience? *

Have you been a PIE preceptor before? *

Is there anything you need us to know about your interest in precepting for this experience?

*

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