Pacific University School of Pharmacy By 11/1/11 – Please return completed form
Advanced and Introductory Pharmacy Practice Experience Program by fax to Rita Barton at Fax: 503-352-7270
(APPE and IPPE) Availability / Site Description Form 2012-2013
Name of Facility: Primary Preceptor/Coordinator:
Facility Address: Facility Phone:
Preceptor Phone: Preceptor FAX#: Email:
Pharmacist License # / Exp. Date: Preceptor License # / Exp. Date:
Facility Web Address:
For planning assistance please contact Lindsay Christensen 503-352-7275 for APPE or Becky Shipman 503-352-7334 for IPPE.
For APPEs please check one of the following boxes for rotation type and for multiple APPE rotation types please complete one (1) sheet per type:
Advanced Community Pharmacy Institutional Ambulatory Care Adult Internal General Medicine Elective /Type:____________________________
Rotation Description:
Enter Number of Students in corresponding fields below – Thank you!
APPE APPE APPE APPE APPE APPE APPE APPE
5/14/12-6/22/12 6/25/12-8/3/12 8/6/12-9/14/12 9/17/12- 10/29/12-12/7/12 12/31/12-2/8/13 2/11/13-3/22/13 3/25/13-5/3/13
10/26/12
APPE – 3rd Yr
Student on 6-
week rotation
Every other Long Term Care (Fall) Long Term Care (Spring)
IPPE-1 – 1st Yr Tuesday
Student
(within 55 mi
radius of
Hillsboro, OR)
Community Setting
IPPE-2 – 2nd Yr 6/25/12-7/20/12
Student Summer
(Anywhere in
OR/WA)
Every other Hospital /Health System Setting (Fall) Hospital /Health System Setting (Spring)
IPPE-3 – 2nd Yr Tuesday
Student
(within 55 mi
radius of
Hillsboro, OR)