Clinical Preceptor Recognition Program Endorsement Form

To honor PAs that serve as stewards of the next generation of PAs, the Physician Assistant Education Association (PAEA) and the American Academy of Physician Assistants (AAPA) have developed a new PA recognition program called the Clinical Preceptor Recognition program.

** If you would like to request a paper version of this form, please email cp@aapa.org**

The following PA would like your endorsement for the Clinical Preceptor Recognition Program:

First Name of Preceptor *

Last Name of Preceptor *

Email *

An endorsement is verification that the above noted PA served as a preceptor for your program and that you support this PA should he or she undertake another preceptor assignment at your PA program.

Endorser First Name *

Endorser Last Name *

Title *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email: *

On behalf of my organization, I fully endorse this applicant for recognition by the PAEA and AAPA Clinical Preceptor Recognition program. *

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