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 our office 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 from the site and preceptor.  * Denotes required fields.

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

    IPPE—CommunityIPPE—InstitutionalAPPE—Community (retail, MTM, management)APPE—Acute Care/General MedicineAPPE—Acute Care/Internal MedicineAPPE—Acute Care/Other

    Please enter specialty area below:

    APPE—Ambulatory CareAPPE—Hospital/Health System (formerly called advanced institutional)APPE—Other or Elective

    Please enter other type of rotation below:

    Name of Preceptor *

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

    Your Email *

    Full Name of Site *

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

    Street Address/City/State/Zip *

    Site Phone *

    Licensure and Experience:

    My state licensure status is current and without reprimand.

    State License # *

    I currently serve as an IPPE/APPE preceptor for

    To prove that you are a human, please answer the following