Virginia Board of Long-Term Care Administrators

Volunteer Preceptors Directory Request Form

This form will add your information to the Volunteer Preceptor Directory. This list is published on the Board’s website and is made available to AITs and the public.

Please be sure to review the Board’s Regulations regarding the Administrator-In-Training Program regularly.

About You
License Number
Your Full Name
Do you have any restrictions of where you can train AITs (e.g. ability to train limited to facilities under same corporate ownership, limited to internal candidates, limited to a certain geographical area, etc.) Yes No

Facility Information
Training Type
Facility Name
Address
City State Zip Code

Contact Info
Email Address
Cell Phone Number
Work Phone Number

By submitting this form, you agree to have this information published on the Board’s website in the Preceptor Directory list.