Pacific University School of Pharmacy 2016-2017
Advanced Pharmacy Practice Experience (APPE)
sopexperiential@pacificu.edu or FAX (503) 352-7398
Contacts: Anita Cleven (anita.cleven@pacificu.edu), Courtney Kraus (courtney.kraus@pacificu.edu)
Nora Garfias (nora.garfias@pacificu.edu), Rose Dahl (rdahl@pacificu.edu)
Name of Facility: _______________________________________________________________
Primary Preceptor/Coordinator:___________________________________________________
Facility Address/City/State/Zip:____________________________________________________
Preceptor Phone:_________________________________Email:__________________________
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Please check the box below that best describes the experience your site offers. For multiple rotation types, complete one
sheet per rotation type (i.e. one sheet for Health System rotations, a second sheet for Internal Gen Med rotations, etc.) For
assistance planning multiple rotations please contact the Experiential Team.
Required/Core Student Coursework
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Elective Student Coursework (Elective Description)
Advanced Community Pharmacy
Health System/Institutional
Ambulatory Care
Internal General Medicine
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Patient Care Elective _________________________________
Non-Patient Care Elective_____________________________
APPE
APPE
APPE
APPE
APPE
APPE
APPE
APPE
5/16/166/24/16
6/27/168/5/16
8/8/169/14/16
9/19/1610/28/16
10/31/1612/9/16
12/26/162/3/17
2/6/173/17/17
3/20/174/28/17
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Students:
Circle Number of
Students:
Circle
Number of
Students:
Circle Number
of Students:
Circle Number
of Students:
Circle Number
of Students:
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of Students:
Circle Number
of Students:
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
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1 2 3 4
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