Request a Preceptor Form - CHRISTUS Trinity Mother Frances Health System

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Request a Preceptor Form

With our vision on education and community service, our goal at CHRISTUS Trinity Mother Frances Health System continues to be assisting with the education process of future health care professionals. With a formal process in place, once we receive your request, we will determine if it meets the basic criteria for further consideration for a clinical rotation within CHRISTUS Trinity Mother Frances. We appreciate the opportunity to serve you, our customers, with your educational needs. Thank you for your interest in pursuing a clinical rotation with our facility.

*Denotes required field

Applicant Information

I am seeking an educational opportunity in the following area

Institution Information

* I have read and accept the requirements below.


As the student, I acknowledge I have satisfied the required immunizations, drug screen and criminal background check and my Institution has on record:

Immunizations: Hepatitis B, MMR, Varicella, Pertussis, TB Skin Test (or Chest X-Ray) Flu. One of the following: 1) Verification of immunization, 2) Request for Religious Exemption from Influenza Vaccination, or 3) Request for Medical Exemption from Influenza Vaccination. Drug Screen, Criminal Background Check

Additionally, I recognize while I am conducting my clinical rotation that I will be required to:

Wear my University Student Name Badge in full view identifying me as a student. If you do not have a current University Student Name Badge you must be sure to have one made through your University before starting your clinical rotation.

Wear any uniform approved by my university or contact my preceptor to determine what is acceptable in the clinical rotation practice. (Uniform scrubs or business attire only. Absolutely no jeans are allowed.)