Preceptor Registration

Name(Required)

First Last

Email(Required)

Password(Required)

Enter Password Confirm Password

Clinical Site(Required)

Clinical Site Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who will be receiving the stipend for completion of this toolkit? (Rural active preceptors only)

If you are a rural active preceptor, please indicate whether you or your organization will be receiving payment and provide a mailing address so that this payment can be sent.

Send payment to me

Send payment to my organization

Disclaimer: By creating an account and participating in Le Moyne’s Preceptor Development Toolkit, participants understand that the Le Moyne College Department of Physician Assistant Studies (DPAS) must follow HRSA guidelines and budgetary restrictions in order to process stipends. To receive stipend payment, The Le Moyne College PA Department will first need to verify your eligibility; if your status as an active preceptor at a rural designated area has not yet been verified, you may not be eligible to receive payment. Payment is subject to funding availability. Individuals and organizations receiving payment must have an updated W-9 on file with the College.

For the purposes of the Preceptor Development Toolkit, individuals eligible for this stipend are defined as followed:

1. A provider who is listed as a preceptor in Le Moyne’s student placement management system (EXXAT); and

2. Is located at a rural-designated site with a current affiliation agreement with the Le Moyne College PA Program. A HRSA-designated rural site is determined utilizing the Rural Health Grants Eligibility Analyzer; and

3. Has precepted at least one Le Moyne College PA student since August 2024.

If you are not an active preceptor but are interested in becoming one visit lemoyne.edu/preceptor to learn more.

Enter the email address where you will be receiving payment.

Enter your organization’s address.

Payment Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code