South Carolina College of Pharmacy

South Carolina College of Pharmacy
2012 - 2013 Availability & Practice Site Information Form

Site Name (include store # if applicable)
Site Address (line 1)
Site Address (line 2)
City		Phone
State		Fax
Zip Code		County
Preceptors
Primary Preceptor		Secondary Preceptor
Degree/Position		Degree/Position
Email Address		Email Address
Tertiary Preceptor
Degree/Position
Email Address
Housing
Housing Available?

INTRODUCTORY ROTATIONS
	1^st Year(P1 students) Community (SCCP 699)			2^nd Year (P2 students) Hospital/Institutional (SCCP 798)
Rotation Dates	May 7 - June 1 2012	June 4 – June 29 2012	July 2 – July 27 2012	May 7 – June 1 2012	June 4 – June 29 2012	July 2 – July 27 2012
# of Students per session

* Please enter the corresponding letter from Key below in the Rotation Type box for each month
ADVANCED ROTATIONS 4^th Year (P4 students)
Month	May 2012	June 2012	July 2012	Aug 2012	Sept 2012	Oct 2012	Nov 2012	Dec 2012	Jan 2013	Feb 2013	Mar 2013	Apr 2013
# of Students per month
Rotation Type*