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  • College of Osteopathic Medicine

    Clinical Faculty Application for Precepting Osteopathic Medical Students

  • Note: In order to have an academic file started for you at Pacific Northwest University of Health Sciences, please complete this application and return with the items requested. You will only be considered Clinical Faculty upon receipt of a letter and certificate from PNWU indicating your appointment.                                                                                                                                           

  • Application Checklist - Please include all the following items:

    • This Clinical Faculty Application and Credentials Verification Form
    • An updated copy of your Curriculum Vitae
    • A copy of your board certification, if applicable
    • A face copy of your current malpractice insurance
    • A copy of your current medical license
    • AOA or AMA number(for CME)
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  • Clinical Faculty Applicants:

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  • Self Identification (Optional)

    This University is an Equal Opportunity Employer and this requested information is voluntary and confidential. A decision not to provide this information will not result in any adverse treatment of your application. It is an unlawful employment practice for an employer to fail or refuse to hire, promote or discharge any individual, or otherwise to discriminate against an individual with respect to that individual's terms and conditions of employment, based on individual's race, sex, marital status, color, religion, national origin, sexual orientation, physical/mental disability or condition, or age (except for those less than 13) as defined by state and federal laws and regulations, except when bona fide occupational qualifications exist that restricts or excludes applicants based on that bona fide occupational qualification.
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  • Credentials Verification

    Credentials Verification

    If you answer yes to any of the following questions, please provide a written explanation and attach to this application.
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  • I attest that all statements made on this form and on any attached documentation are complete, accurate, and current. I understand that any material misstatements in, or omissions from, this statement constitute cause for denial of application, or faculty suspension/dismissal from Pacific Northwet University of Health Scienes.

    I have read and agree to abide by the PNWU Ethical Conduct Policy which includes adherence to the ethical code of my profession: https://code-medical-ethics.ama-assn.org/principles 

    I understand and consent to a Federation of State Medical Board FSMB review being conducted by PNWU to process this application.

    Serving as a PNWU-COM preceptor does not constitute an employment contract or offer of employment express or implied. PNWU may use preceptors' names for accreditation purposes.

    I affirm that I am duly licensed to practice medicine and have current medical malpractice insurance. I will notify PNWU-COM immediately of any changes to my practice status.

    I understand and agree to keep student and other PNWU related information confidential and disclose such information only to authorized PNWU personnel

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