Kare Drug Community Pharmacy Fellowship

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Name *

Phone Number *

Personal Email (Non-school) *

Wiling to relocate to Bloomfield or Aztec New Mexico? *

Yes

Year of Graduation *

I understand that this is a 18 Month Commitment *

Yes

Have you worked at a Independent Community Pharmacy? *

Yes

Tell us why you are interested in the Kare Drug Fellowship *

Are you a NCPA Member? *

Yes

How did you hear about the Kare Drug Fellowship?
*

Describe your community pharmacy experience, internships, IPPE, APPE, and professional. This should include roles played (from technician to charge agent) *

Describe your experience working with and leading teams *

Why do you want to participate in the fellowship and what do you hope to accomplish? *

Where do you see yourself in 5 years? *

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