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Career Mentor Activity Approval
Person Requesting Approval (Last Name, First Name)
Phone Number (inlcude area code)
Other (please specify below)
If other was selected in Question #4, please specify activity (please provide any needed explanation of event if not a presentation, shadowing, or interview experience):
Time event occurring
Location of event
Name of Pharmacist Speaker
Work place of Pharmacist
Job position of Pharmacist
(i.e. Residency Director, Corporate Management, Staff Pharmacist, etc)
List Career Area of Pharmacist if group activity involves a speaker
i.e. Community Pharmacy, Patient Centered Medical Home, etc
Sponsoring Student Organization (if applicable)
Who will pick up the parking pass for the career mentor & what date would you like to pick it up?
Upload any mock ups of flyers/advertisements that need to be approved by Dr. Grant.
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