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MERIT Clinical Preceptor Registration for Summer 2025

Thank you for your interest in becoming a MERIT Clinical Preceptor. On Tuesdays and Thursdays this summer, 30 MERIT Scholars (rising Seniors) will spend 5 weeks shadowing different health care professionals, like you! These shadowing experiences are often life-changing for our scholars and can ignite a long-term passion for pursuing careers in the health professions. Thank you in advance for creating a welcoming learning environment! If known/available, please have the following information on-hand before beginning this registration form: - your JHED ID - Month & Year of your last criminal background check through JHU SOM Human Resources MERIT will share the information you provide in this form with the JHU SOM Human Resources department for next steps. If you were not a preceptor last summer, please anticipate that JHU SOM Human Resources will likely reach out to you directly for additional training or documentation for your clearance to work with minors. On the other hand, MERIT staff will work directly with the JHU SOM to have our scholars cleared and to obtain their badges so this will not be your burden. Thanks again!!

Salutation
If unknown, you may leave blank and we will follow up with you as needed
What is your affiliation with JHU School of Medicine?
if unsure, you may leave blank and we will follow up with you as needed
Which Department(s) are you in?
What is your Division?
  • {name}
Contact Info for your Admin Assistant (if applicable)
Name, Email address, Cell Phone Number
  • {name}
Please select the most appropriate option(s)
Please select your clinical site(s) where our scholars might shadow you.
  • John Hopkins Hospital (JHH)
  • John Hopkins Bayview Medical Center (JHBMC)
  • John Hopkins Outpatient Clinic (JHOC)
  • John Hopkins Community Physicians- East Baltimore (JHCP-EB)
  • Chase Brexton (CB)
  • University of Maryland Medical Center (UMMC)
  • Baltimore VA Medical Center
  • Mercy Medical Center
  • Other
Please indicate your current position.
Have you volunteered as a preceptor w/MERIT before?
Have you completed the Johns Hopkins Child Safety Training within the last year?
if you are estimating, please include a question mark
Please provide any other comments, questions, or concerns you have about becoming a MERIT Clinical Preceptor below.
  • {name}

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