MKE-Clinical Apprenticeship Sign Up Form | Teaching Toolbox

Academic and Student Services

蝌蚪窝 Clinical Apprenticeship Sign Up Form

Discovery Curriculum Teaching Toolbox

Thank you for your interest in the Clinical Apprenticeship and Preceptor program in the Discovery Curriculum at the 蝌蚪窝. Please complete this form to add your name to our database for future student assignments. Any questions about the program, contact Dana Sibilski (dsibilski@mcw.edu) or (414) 955-8196.

Physician Information

First Name

Last Name

Title

Employer

Specialty

I am an existing faculty or volunteer faculty at MCW Yes No

Contact Information

Physician Email *

Physician Phone

Physician Pager

Assistant Name

Assistant Email

Assistant Phone

Facility Information

Hospital or Clinic

Address where student would report

City

Availability

In order to participate in the Early Clinical Experiences Clinical Apprenticeship program, physicians would be required to host a student for four hours on either Monday afternoon, Tuesday afternoon, Thursday morning or Friday afternoon.

Monday afternoon Tuesday afternoon Thursday morning Friday afternoon

Let us know if you have questions or have any additional information to include

Non-Discrimination, Anti-Harassment, and Legal Compliance Statement
The 蝌蚪窝 (MCW) is committed to fostering a diverse community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, military status, or other legally protected classification. MCW maintains full compliance with all applicable federal, state, and local laws and regulations in pursuit of our missions. Consistent with federal guidance, we affirm our commitment to individual merit, fairness, and equal treatment in all aspects of academic and institutional decision-making.

MCW's policies, federal and state laws, and regulations prohibit unlawful discrimination and harassment. Employees, learners, students, applicants, or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.