Preceptor Interest Form

First Name*

Last Name*

Email*

Phone*

CA RPh license number

Current practice facility (name of hospital, pharmacy, clinic, business, etc.)

City of current practice site

Have you precepted Pharm.D. students from any school in the past 5 years?

Yes

Pharmacy degree institution (university, school, or college)

Year pharmacy degree earned

Are you a UCI alum?

Yes

Are you interested in joining our extended alumni network “Anteaters in Pharmacy”?

Yes

I’m already part of Anteaters in Pharmacy. Zot Zot Zot!

Student Affairs Office
209 Steinhaus Hall, Bldg 502
Irvine, CA 92697
949.824.1991

Administration Office
101 Theory, Ste. 101
Irvine, CA 92697-3958

Privacy Policy

Privacy & Legal Notice

Copyright Information

Preceptor Interest Form

Privacy Policy

Quick Links

Departments

Programs

© All rights reserved UCI School of Pharmacy & Pharmaceutical Sciences