New Preceptor Interest Form » Office of Experiential Programs » College of Pharmacy

If you have any questions regarding this form please email preceptor-support@cop.ufl.edu
Name*
First Last
Credentials (PharmD, PhD, etc.)*
License Number*
Email*
Enter Email Confirm Email
Work Number*
Proposed Rotation Type(s)*
- Community Practice
- Ambulatory Care
- Hospital Practice
- General Medicine
- Elective
- International Health Outreach Trip
- Career Coach Program
Elective Title*
Site Name (Please include store number if applicable)*
Site Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you already have a PharmAcademic login/account?*
If yes, what email is associated with your login/account?*
As part of submitting my interest in serving as a UF preceptor, I agree to complete the required trainings as part of orientation and as scheduled thereafter.*
- Yes, I agree to complete the required trainings as part of orientation and as scheduled thereafter.
Please upload a copy of your CV.*