Volunteer Preceptor Sign-Up and Credentialing Form

Thank you for your interest in becoming a volunteer preceptor for our dental students in a community health setting. As a preceptor, you’ll play a vital role in mentoring future dental professionals and serving our community.


Please complete the following form to begin the credentialing process. Note that the following items are required for your application:


Current License: Upload a copy of your valid dental license.

Liability Insurance: Confirm by checking the box below that you carry your own liability insurance and that it will cover your volunteer activities in our program.

Letter of Support: Provide a letter from a licensed dentist who has observed or worked with you, attesting to your character and professionalism. Upload this letter as part of your application.

 
 
 

Please select your affiliation from the options below:

 
Phone
 
 

To help us schedule and match you with students effectively, please provide your typical availability.

 
 

Required Attestations and Document Uploads

Please check the box below to attest that you have active liability insurance and will use it during your volunteer service.