Emory University

WOCNEC


Application

for

Alternate Clinical Provider

(Continence Only)


We are delighted you are interested in serving as an off-site Alternate Clinical Provider for the Emory University Wound, Ostomy, and Continence Nursing Education Center (WOCNEC).


The information requested below is required to meet accreditation standards. You will note all the eligibility requirements are listed first to avoid wasted efforts if you are not currently eligible.


If you have any questions, please contact us at: wocnec@emory.edu or If you have any questions, please contact us at: wocnec@emory.edu or 404-778-4067.

New Application*

Eligibility Requirements

Clinical Experience*

Must specialize in urology and/or continence and be clinically competent to provide preceptorship for continence students.


I attest that I meet the Clinical Experience requirement.

Unfortunately, it appears you do not meet eligibility requirements at this time.

No minimum requirement.

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No minimum requirement.

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Certification not required.

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Contact Information

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Phone

Optional

Phone
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Preferred Email*

Clinical Practice

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Only include the setting(s) you will be precepting in.

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If precepting in multiple settings, choose the range that corresponds with the setting you will spend the most time precepting in.

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Preceptor to Student Ratio*

Maximum 1:2

%'s must equal 100%

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Is there a specific student you are applying to precept for?

Thank you!

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