2025 THA Preceptor Incentive Program

THA Nursing Preceptor & Apprenticeship Information
By completing this form, I understand that in order to be eligible for this program, your preceptorship must meet the following requirements:

1. Preceptor hours must be with a nursing student, in an direct preceptor relationship (ex. 1:1, DEU, APP, Apprenticeship Mentor). 2. Preceptor hours must occur in Tennessee. 3. All elements of the preceptor program (training & documentation) must be completed. 4. All items must be completed and submit by the due date. All information can be found here: THA Nurse Preceptor Incentive - Tennessee Hospital Association
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Registered Nurse license number*
If applicable, APRN License Number
Please indicate your license type*

LPNRNAPRN
Current certification(s)? (i.e., CCRN, CEN)*
Are you currently in a paid preceptorship program or receiving payment for precepting students?*

Yes, Provide by academic agencyYes, Provided by employerNo
Have you completed preceptor training courses outside of those required for this program? (i.e., employer, self-study)*

YesNo

By completing this form, I understand that in order to be eligible for this program, your preceptorship must meet the following requirements: