TX ACP GIMSPP Preceptor Availability Form 2026

GIMSPP Preceptor Availability Form 2026
Eligibility Requirements:
- Preceptor must be board certified in internal medicine with a current Texas medical license.
- Preceptor must practice at least 40% as a general internal medicine physician apart from any other subspecialties.
- Preceptor must be able to commit to either a two, three, or four week commitment during the summer.
- Preceptor is expected to provide daily personal instruction and supervision to a medical student.
Name*

First NameLast Name
Practice Name*
Practice Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone Number*
Format: (000) 000-0000.
Administrator Information

We will contact your administrator to verify affiliation agreements, paperwork, training, etc, as needed for students to precept with you.
Administrator Name*

First NameLast Name
Administrator Email*
Administrator Phone Number*
Format: (000) 000-0000.
Preceptor & Practice Information
YesNo
Solo PracticeGroup PracticeEmployed Physician / HospitalSingle SpecialtyMulti-SpecialtyEmergency Care ClinicMedical Home
No, no affiliation with any medical school. I can precept a student from any program.BCMH - Baylor College of Medicine HoustonBCMT - Baylor College of Medicine TemplePLFSOM - Texas Tech University Health Sciences Center Paul L. Foster School of MedicineSHSUCOM - Sam Houston State University College of Osteopathic MedicineTAMUHSC - Texas A&M Health Science Center College of MedicineTCU - Burnett School of MedicineUNTHSC/TCOM - University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic MedicineTTUHSC - Texas Tech University Health Sciences Center School of Medicine - LubbockUHCOM - University of Houston College of MedicineUIWSOM - University of the Incarnate Word School of Osteopathic MedicineUTDell - The University of Texas at Austin - Dell Medical SchoolUTHealth - The University of Texas Health Science Center at Houston McGovern Medical SchoolUTHSCSA - The Joe R. and Teresa Lozano Long University of Texas School of Medicine at San AntonioUTMB - The University of Texas Medical Branch at GalvestonUTRGV - The University of Texas Rio Grande Valley Medical SchoolUTSW - The University of Texas Southwestern Medical CenterUT Tyler - UT Tyler School of Medicine
YesNo
Which one(s)?
YesNo
Primary SpecialtySubspecialtyNeither
Please list any specialties you have other than Internal Medicine.*
Were you invited to participate in GIMSPP directly by a student? Please tell us their name so we can facilitate the match process.
How many students will you accept at one time?
How many students can you accept over the course of the summer?*
Do students need to speak another language to participate effectively in your practice?*
Please specify which language.
Preceptorship Availability
Matches are made between May and August.
- Please list dates below if there are any dates that you would not be available to accept students. If you have open availability, please leave this question blank.
- Preceptorships last 2-4 consecutive weeks during the summer, beginning on a Monday and ending on a Friday.
- Our most requested dates from medical students are during June and July, but preceptorships can take place anywhere between May and mid-August.
- If you have any dates that you would be unable to participate between May and August, please let us know below. We will always confirm match dates before we finalize a match, but this helps us plan in advance.
Unavailable Start Date 1
Unavailable End Date 1
Unavailable Start Date 2
Unavailable End Date 2
Additional Information
Please let us know if there is anything else students may need to know or provide before beginning their preceptorship.
Past examples includes but not limited to vaccination records, HIPPA training, and an application for the hospital to approve.
Do you have a colleague you could recommend to the program? If so, please list their name and contact information below.
Should be Empty:

GIMSPP Preceptor Availability Form 2026

Administrator Information

Preceptor & Practice Information

Additional Information