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PA Program Preceptor Interest Form

Thank you for your interest in becoming a preceptor for the University of Wisconsin–Madison Physician Assistant program. Being a preceptor is a great way to assist in the education of future physician assistants by sharing your knowledge and guidance.

In order to be a preceptor, you need to be a MD/DO, PA or NP who is licensed and board certified in your area of practice.

"*" indicates required fields

Name*
City and State
Have you precepted before?*
I understand that by submitting this form, my information will be used to contact me regarding my interest in becoming a preceptor with the UW–Madison Physician Assistant program.*