Preceptor Application

This is the application for all ASM and BSM preceptors at NCM. There are 3 steps to completing the application process: 1) Application, 2) Orientation, and finally, 3) Enrollment. This first step takes approximately 15 minutes to complete and must be completed in one sitting.

As NCM faculty, you will need to complete MEAC-Required Annual Training for Preceptors each year. Thank you for training the next generation of midwives.

We do not process applications from Dec 15 - Jan 15th (Calendar).

Preceptor Details

Only used for a more personal connection and has no influence on acceptance as a preceptor.

Note: For the purpose of this database entry, non-academic means clinical preceptor.

Please input only numbers. (International numbers should include country code without parenthesis.)

NCM email addresses are first name, last initial, ##@midwiferycollege.edu (Examples: monicab34@midwiferycollege.edu, tyrong78@midwiferycollege.edu)

Please type your desired email address in full.

NCM reserves the right to change your desired email during the enrollment process.

Only used for verification purposes. Use the calendar or type in your date of birth (MM-DD-YYYY). To use the calendar, double click on the month at the top to access your year, month and date of birth.

A preferred pronoun is a pronoun an individual chooses to identify with and would prefer others use when talking to or about that individual. It is the pronoun that a person uses for themself.

Please provide the address at which you receive mail. This address is not necessarily the clinical practice address.

“Each one, teach one”

Certificate and License Information

Must be at least 3 years prior to today's date. If date is less than 3 years prior to today's date, please contact the office for instructions on proving you have done a minimum of 50 births as the primary attendant.

Use the calendar or type in the date (MM-DD-YYYY). To use the calendar, double click on the month at the top to access your year, month and date.

If you are an ACADEMIC ONLY preceptor write that in this field please.

If your clinical location is not listed then NCM does not have permission to have students at this location at this time. Please contact Marcy at marcya@midwiferycollege.edu to discuss updating this list.

NOTE: NCM only requires one Provider Certificate or License.

You will have the option to upload others in subsequent fields.

Use the calendar or type in your date (MM-DD-YYYY). To use the calendar, double click on the month at the top to access your year, month and date.

Clinical Site

(Numerical Only.)

(Numerical only.)

"Continuity of care" means connecting the student with a client for which they can provide primary under supervision care which includes prenatals in each trimester, labor and delivery and postpartum care.

Student Information

Write the first and last name of each student followed by the word "current". If you are applying to be NCM faculty before you have a student relationship, put "applying" in this field.

If you are applying to be BSM faculty only, put "NA".

For example:
Natasha Hill current
Kiko Nako current

Write the first and last name of each student followed by the word "current". If you are applying to be NCM faculty before you have a student relationship, put "applying" in this field.

If you are applying to be ASM faculty only, put "NA".

For example:
Natasha Hill current
Kiko Nako current

Optional: Demographics (your answers do not affect your ability to become faculty, but help NCM secure funding)

How many hours do you work for pay outside of your birth work and precepting work?

In addition to being a preceptor for NCM, I also have significant care-giving responsibilities for someone living in my home (other than my own children).

What is the most important support that you have had or are receiving currently?

What type of support do you feel would be most helpful for you as a preceptor?

What do you anticipate will be OR has been the most difficult personal challenge to precepting your student's NCM program of study?

What has been your greatest personal strength in working with your student through their program of study?

The National College of Midwifery prohibits discrimination, harassment, retaliation, or discipline against any NCM community member or group including but not limited to the board of directors, volunteers, faculty, staff, contractors, prospective or current student on the basis of their actual, implied or perceived; because of race; color; national or ethnic origin or ancestry; religion or creed; age, sex, gender, gender identity or expression, including transgender identity; sexual orientation; marital status; familial status; age; ability/disability; genetic information; economic status, formal education, language, citizenship status, veteran status, genetic and/or ancestry information, political affiliation or other identities, including any other protected category under federal, state or local law. All personnel who are responsible for recruitment, admissions, hiring and promoting and for the development and implementation of college programs are entrusted to hold up this standard and to respond promptly and appropriately to any concerns that are brought to their attention.

Other Opportunities and Quality Improvement

Do you have a CEU course you are approved to teach and would like to offer it through our online learning platform? Do you have a specialty course that you would like to get approved for CEUs and offer it to midwives or midwifery students? La Plaza is the place to market your class and maximize capability, advertising, and enrollees!

×

Upload Image

Upload
To crop this image, drag a region below and then click "Save Image"
Uploading