to review the Preceptor Commitment Letter for the participation in the RSA Fellowship Network 2022/2023.
I understand that as a Philanthropic Preceptor, the Program Fee is waived, and shall not affect the remainder of this Commitment Letter which shall continue to be in force.
By completing the form below, I submit my enrollment as a Fellowship Preceptor and Founder in the RSA Fellowship Network. I have reviewed the Preceptor’s Invitation Letter Dated January 26, 2022, (Click Here to Download)
and acknowledge the scope of the program. I understand this program provides each Fellow with a unique “networked” format for the fellowship and entitles them to participate in extensive training in a virtual environment, as well as access to electives at other RSA clinical sites and other programs. I further understand that as a Philanthropic Preceptor, my Program Fee is waived.
PRACTICE / SITE INFORMATION
INCOMING 2022 FELLOW INFORMATION - FELLOW #1 (If Known)
INCOMING 2022 FELLOW INFORMATION - FELLOW #2 (If Known)
ADMINISTRATIVE CONTACT INFORMATION