Pacific University School of Pharmacy 2015-2016 Advanced Pharmacy Practice Experience (APPE) sopexperiential@pacificu.edu or FAX (503) 352-7398 Contacts: Jeremy Hughes (jeremy.hughes@pacificu.edu), Courtney Kraus (courtney.kraus@pacificu.edu) Nora Garfias (nora.garfias@pacificu.edu), Rita Barton (bartonr@pacificu.edu) Name of Facility: Primary Preceptor/Coordinator: Facility Address/City/State/Zip: Preceptor Phone: _Email: 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 Community Pharmacy rotations, a second sheet for Elective rotations, etc.) For assistance planning multiple rotations please contact the Experiential Team. Required/Core Student Coursework Elective Student Coursework (Elective Description) Advanced Community Pharmacy Patient Care Elective _______________________________________________________ _______________________________________________________ Non-Patient Care Elective _______________________________________________________ _______________________________________________________ APPE APPE APPE APPE APPE APPE APPE APPE 5/11/156/19/15 6/22/157/31/15 8/3/159/11/15 9/14/1510/23/15 10/26/1512/4/15 12/28/152/5/16 2/8/163/18/16 3/21/164/29/16 Circle Number of Students: Circle Number of Students: Circle Number of Students: Circle Number of Students: Circle Number of Students: Circle Number of Students: Circle Number 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 1 2 3 4 Other #___ Other #___ Other #___ Other #___ Other #___ Other #___ Other #___ Other #___ TOTAL NUMBER of APPE STUDENTS