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First name

Last name

Please enter your mailing address below.

Street address

City

State

Zip code

Contact phone number - please enter as (area code) xxx-xxxx

Email address

Have you ever been employed by Stony Brook School of Nursing?

Please choose the highest degree you have obtained. Do not include a program which you are presently enrolled in.

PhD
EdD
DNP
Post-Masters
Masters in Advanced Practice Nursing
Masters in Education
Bachelors

Have you completed any formal education courses?

Yes, I have completed a degree/ certificate in education
Yes
No, however I am enrolled
No

Click on the level(s) of student which you are interested in shaping the future of. You may choose multiple answers.

Undergraduate Nursing
Graduate, Advanced Practice Nursing
Graduate, Nursing Leadership Program
Graduate, Nursing Education Program
Doctoral, DNP

Which of the following would you be interested in gaining further teaching experience, whether it be at an undergraduate or graduate level?

You may choose more than one answer.

Clinical, hospital
Nursing Bed Lab
SIM
Didactic, Classroom
Didactic, Distant Education
Nurse Practitioner preceptor (click and see question below)

If interested in teaching undergraduate clinical, which best describes your area of interest? Choose one answer.

All others please move on to the next item.

Pediatrics
Obstetrics/ Women's Health
Psychiatric/ Mental Health
Community Health
Med-Surg

If you are a practicing Nurse Practitioner and interested in becoming a preceptor for our advanced practice nursing students, please click on the area of your practice. Choose one answer. All others, please move on to the next item.

Primary Care, Adult
Women's Health
Cardiology
Psychiatric/ Mental Health
Child Health
Neonatal
Gastroenterology
Infectious Disease
Pulmonary
Critical Care
HEENT
Nephrology
Orthopedics/ Sports Medicine
Diabetes/ Endocrine
Urology
Veteran's Health
Oncology
Dermatology

Please upload your CV in PDF format. Uploading from a mobile device is rarely supported.