Nurse Preceptor Academy

Make A Difference in Kansas City Health Care

The Nurse Preceptor Academy is a dynamic full-day workshop that trains registered nurses for the role of preceptor at Kansas City area hospitals.

To register for this program, please complete the following form. All fields are required.

The registration deadline for the Nurse Preceptor Academy is three weeks before the session.

Because hospitals are allocated a limited number of spaces for each session of the Nurse Preceptor Academy, you will need a hospital code to register.

If you need to cancel your registration for either program, click here.

* required fields

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Registration Code   Don't know your code?

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First Name*	Last Name*
Title/Work Role/Department*
Hospital*	--Please Select-- Centerpoint Medical Center Children's Mercy Hospitals and Clinics Kindred Hospital Kansas City Lee's Summit Medical Center Liberty Hospital Menorah Medical Center Olathe Medical Center Other Overland Park Regional Medical Center Providence Medical Center and Saint John Hospital Research Medical Center Saint Luke's East - Lee's Summit Saint Luke's Hospital of Kansas City Saint Luke's Northland Hospital Saint Luke's South Hospital Shawnee Mission Medical Center St. Joseph Medical Center St. Mary's Medical Center Truman Medical Center, Hospital Hill Truman Medical Center, Lakewood University of Kansas Hospital Veterans Affairs Medical Center of Kansas City
Work Phone*	Home Phone*
E-mail*
Home Address*
City*	State*  AA AE Alabama Alaska Alberta, Canada AP Arizona Arkansas British Columbia, Canada California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam, US Territory Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba, Canada Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick, Canada New Hampshire New Jersey New Mexico New York Newfoundland, Canada North Carolina North Dakota Northwest Territories, Canada Nova Scotia, Canada Nunavut, Canada Ohio Oklahoma Ontario, Canada Oregon Pennsylvania Prince Edward Island, Canada Puerto Rico, US Territory Quebec, Canada Rhode Island Saskatchewan, Canada South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands, US Territory Virginia Washington West Virginia Wisconsin Wyoming Yukon Territories, Canada ZIP*
Years of Nursing Experience* 1-5 years6-10 years11-20 years21+ years
Age Category* 20-2930-3940-4950 and older
Have you participated in other formal preceptor* training? YesNo
Have you worked as a preceptor during the past year?* YesNo
Date Attending Preceptor Academy* Sept. 25 - Centerpoint Medical CenterOct. 23 - Lee's Summit Medical CenterNov. 14 - St. Joseph Medical Center
If you have special requests, including physical or dietary accommodations, please list them in the following box.

A list of participants and their contact information, including work phone and e-mail address, will be distributed to participants. If you do not want either shared, please check the corresponding box.

No, I do not want to share my work phone with participants.

No, I do not want to share my e-mail address with participants.