Preceptor Interest Form Contact us by filling out the form below. Preceptor Interest Form Name * Name First Name First Name Last 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 PharmD students from any school in the past 5 years? Yes No Pharmacy degree institution (university, school, or college) Year pharmacy degree earned Are you a UCI alum? Yes No Are you interested in joining our extended alumni network “Anteaters in Pharmacy”? Yes No I’m already part of Anteaters in Pharmacy. Zot Zot Zot! If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit