The FIU Preceptor Request Form, field by field
Florida International University (FIU) gathers every proposed preceptor and site on one document: the Preceptor Request Form, Appendix A of the Advanced Practice Nursing Programs Clinical Preceptor Manual, revised 3/31/2022. It asks about you, the preceptor, the facility, the course and the schedule, carries your faculty member's signature, and ends with a part FIU staff complete about the site's last evaluation and the preceptor's license. A complete form is the quickest route to an approved rotation.
Get your placement plan
Tell us your FIU program and where you live. A placement advisor replies with the preceptor and site options that fit your FIU course.
Where the form comes from and where it goes
The form sits at the back of FIU's 2022 preceptor manual as Appendix A, alongside the preceptor evaluation (Appendix C) and the Clinical Rotation Time-Sheet Log (Appendix D). The manual says preceptor suggestions go to the clinical faculty, and it asks for them at least 8 weeks before the date you want to begin.
From there the form feeds two decisions. Your faculty member signs to approve the pairing, and the NWCNHS Office of Clinical Education checks whether the site and preceptor hold every contract and document FIU requires. If the practice is not yet an approved FIU-NWCNHS site, the form itself warns that obtaining an agreement may take up to 6 weeks. Keep a dated copy of what you submit, so you can answer questions about it later.
Every field, and what to put in it
The fields look simple, yet vague entries invite follow-up questions: a practice with several locations and no clear address, a schedule written as flexible, or a specialty that does not match the course. Precise answers let the faculty signature and the office's check happen in one pass.
| Part of the form | What it asks | What to have ready |
|---|---|---|
| Student | Your details and your specialty | Your track as FIU names it, such as Pediatric Primary Care |
| Preceptor | Name, specialty and email | An email address the preceptor actually reads |
| Facility | Practice or facility name and address | The address where you will see patients |
| Typhon list | Whether the preceptor is already on the Typhon NWCNHS approved list | Ask whether they have precepted FIU students before |
| Course | Clinical Practicum-I, Clinical Practicum-II, Role Synthesis, Research or DNP Residency 1-3 | The course on your current plan of study |
| Schedule | Term, start and end dates, clinical days and times | The weekdays and hours the preceptor agreed to |
| Faculty approval | Your faculty member's signature | Requested once every other field is filled |
| FIU use | Date of the last site evaluation; preceptor license and expiration | The license details, so staff can record them |
Picking the course on the form
The form's course list (Clinical Practicum-I, Clinical Practicum-II, Role Synthesis, Research and DNP Residency 1-3) follows the older course structure. The current graduate handbook matches it, listing two practicums plus Clinical Decision Making (NGR 6209 or NGR 6337C) and Role Synthesis (NGR 6700L or NGR 6337L).
The plan of study revised 5-2026, effective from Spring 2027, uses three practicums instead: NGR 6201L, NGR 6202L and NGR 6203L for Adult-Gerontology, and NGR 6301L, NGR 6302L and NGR 6303L for Pediatrics, with NGR 6744 beside the last one. If your course number has no obvious match among the form's choices, ask your clinical faculty which option to mark, and add the course number so the entry cannot be misread. DNP students choose among the residency options; the DNP residency faculty can confirm which one fits your current course.
Who signs and what FIU staff check
The faculty approval signature is the form's decision line, which is why everything else should be filled in before you ask for it. After that, FIU staff complete their own part: the date of the site's most recent evaluation and the preceptor's license with its expiration date.
That staff check connects to rules that sit outside the form. FIU's handbook looks for a year or more in the specialty, current licensure and national certification, and Florida's rule 64B9-4.001(13) adds that a preceptor supervising you in Florida must be Florida-licensed; both rules are explained on the preceptor requirements page. A license due to expire during the semester is worth raising early, because the expiration date goes on the form.
Check the preceptor's license before you file: FIU staff record it with its expiration date, and a Florida site needs a Florida-licensed preceptor under rule 64B9-4.001(13).
Timing the submission
File during the semester that precedes the practicum, the window FIU's handbook uses for arranging rotations. At a practice FIU already has an agreement with, the manual's 8-week notice is the working deadline; for a new site, allow for the agreement too, which the current handbook estimates at 6-8 weeks. The form's own 6-week warning is the shortest of FIU's figures, so plan to the handbook's. The site contracts page shows how FIU's different figures fit together.
One form does not lock in the placement. Per the manual, proposing a site gives you no claim on a contract or a rotation there, so if the practice is new to FIU, line up a second preceptor and keep their details ready for a second form. The semester-before planner puts these deadlines on a calendar.
A check before you ask for the signature
Before the form goes to your faculty
- The specialty matches your track and the course's patient group.
- The facility address is the one where you will see patients.
- The preceptor's email is one they check, since FIU's coordinator may write to them.
- The days and times match what the preceptor agreed and fit the Monday-to-Friday primary care pattern.
- The start and end dates sit inside the official semester; break-week clinical days need your faculty's emailed approval.
- The preceptor's license, certification and experience meet FIU's rules and Florida's.
- No family member, close friend or your own unit is involved.
Each line maps to an FIU rule, so checking them first saves a round of questions after submission and gives your faculty a request they can sign on the first read.
How we prepare your request
When we match you with a preceptor, the request is built alongside the match. We confirm the preceptor's specialty, license and expiration, certification and experience against FIU's rules; we record the facility address, a working email and the agreed weekdays and hours; and we note the practice's FIU contract status and whether the preceptor is already approved in Typhon.
You receive those details in the order the form asks for them, ready for your faculty's signature, and if the practice is new to FIU we tell you straight away so the contract lead time goes into your plan. Your faculty and the Office of Clinical Education still decide; they simply receive a request with no gaps to chase. The form below is the place to start.
Questions FIU students ask
Where do I get the FIU Preceptor Request Form?
It is Appendix A of the Advanced Practice Nursing Programs Clinical Preceptor Manual, AY 2022/2023 edition, which FIU hosts among the college's resources. Ask your clinical faculty whether your course uses a newer copy before you fill in the manual's version. The same manual holds the evaluation form and the time-sheet log you will need later in the rotation.
Do I need a new Preceptor Request Form each semester?
Each form names a course, a term and dates, so every new practicum needs its own entries even with the same preceptor. Switching site or preceptor between terms is allowed, and every switch needs a fresh request. Ask your clinical faculty whether a continuing preceptor needs a full new form or an update for the new course.
What does the Typhon approved list on the form mean?
It refers to preceptors already approved in Typhon, the system FIU students use to log clinical encounters, so a preceptor on that list is already known to FIU. If you are not sure whether your preceptor is on it, ask the Office of Clinical Education to check. The Typhon guide explains how the system is used once the rotation starts.
Can I submit the form before my clearance is finished?
Clearance has to be finished by the time the rotation begins, not by the time you file, and the handbook sets no fixed number of weeks for it. Filing the form while your Complio or FIU Express items are still posting lets the contract work and your clearance move forward at the same time, which protects your start date.
Does a signed form mean my rotation is approved?
Not by itself. The faculty signature approves the pairing, but the NWCNHS Office of Clinical Education still checks the contract and the documents for both site and preceptor, and a new site needs its agreement in place first. Wait for confirmation that all of it is done before your first clinical day.
Related pages
Last checked 2026-09-26
We check these pages against FIU's own graduate handbook, preceptor manual, plans of study, catalog and licensure pages. Your plan of study, your course faculty, your clinical faculty and FIU's Office of Clinical Education have the final word.
FIU asks you to identify your clinical site. We make that the easy part.
Tell us your FIU track, where you live and which semester your next practicum starts. We find preceptors whose patients fit the course, check early whether the site already holds an FIU contract, and prepare everything the Preceptor Request Form asks for.
- Preceptors matched to the course: adult and older-adult primary care for
NGR 6201L, pediatric primary care forNGR 6301L, an organizational mentor forNGR 7940C - Preceptor, facility, license and schedule details ready for the Preceptor Request Form, weeks ahead of the contract clock
- Across Miami-Dade, Broward, Palm Beach and Monroe, or beyond them where FIU approves your site
Start your placement plan
Track, city and semester is all we need to begin.