Thank you for taking the first step to becoming a Preceptor for the Presbyterian College School of Pharmacy.

Please fill out the form below and someone from the Office of Experiential Education will contact you to learn more about the experience that you would like to offer. Please note that new preceptors are accepted based on need, location, and the student experience provided.

 

PLEASE PROVIDE THE FOLLOWING INFORMATION FOR THE SITE AND PRECEPTOR. *DENOTES REQUIRED FIELDS.

    *Type of Rotation (check all that apply; please provide description of “other” types and specialties):

    Comments: Please enter specialty area and/or information about “other or elective” type of rotation::

    *Name of Preceptor

    *Credentials (PharmD, RPh, MD, NP, etc.)

    *Your Email

    *Full Name of Site

    Name of Site's Corporate Entity (if site is not privately owned)

    *Site Street Address

    *City/State/Zip

    *Site Phone



    Licensure and Experience:
    My state licensure status is current and without reprimand.

    *State of Licensure and License Number:

    I currently serve as an IPPE/APPE preceptor for

    *I graduated from the following school of pharmacy in the year indicated: