MOREHOUSE SCHOOL OF MEDICINE
PUBLIC HEALTH AND PREVENTIVE MEDICINE

LEARNING CONTRACT

 (Please submit or fax to the program office at (404) 752-1160)

1.   Complete the form on this web page.
2.   Print the form (for signatures), before you click Submit.
3.   Click Submit.
4.   Send or FAX signed form to the program office at (404) 752-1160). 

Resident Name
Preceptor
 
   Resident Goals and Objectives (Please include a list of competencies that will be met during this rotation):

   Specific Strategies :
   Preceptor Goals and Objectives :
    Specific Strategies :
   Oral Communication Requirements :
   Written Communication Requirements :
   Time Limitations (Attach agreed upon schedule) :
   Evaluation Process :
   Progress Report :

Resident Signature: 
Date:
Preceptor Signature:  Date:

Remember to Print this form before you Submit. 
Then Sign and Send or FAX signed form to:  (FAX 404-752-1160).