Pharmacy Preceptor Interest Form - Wayne State University

Pharmacy student surveys conducted through the American Association of Colleges of Pharmacy have consistently demonstrated that experiential education is one of our PharmD program's greatest strengths, thanks to our dedicated preceptors. If you'd like to become a preceptor for our driven and eager Wayne State pharmacy students, please fill out the form below.

Fields with asterisks (*) are required.

First name *

Last name *

Email *

Secondary email address

Current employer

Current position

Site address

Address line 1

Address line 2

City

State/province/region

Postal/zip code

Country

Home address

Address

City

State

Zip Code

Business phone

Alternate phone

Pager

IPPE rotation to be precepted

Community

Hospital

N/A

APPE rotations to be precepted

Pharmacy school attended

Date of graduation

(1) Residency program completed (if applicable)

Date completed

(2) Residency program completed (if applicable)

Date completed

Additional comments