Forms for New Preceptors and/or Practice Sites

Below is a list of forms for new preceptors and/or practice sites.  Please submit these forms and any applicable documents to the Professional Experience Program by email: cop-iowa-prof-exp@uiowa.edu, fax: 319-353-5646, or mail: 115 S. Grand Avenue, S411 PHAR, Iowa City, IA 52242. 

  • New Preceptor Information Form (PDF iconView Preceptor Information Form) We provide adjunct faculty appointments to all of our preceptors and need this information to process the appointment. This must be signed and then scanned and emailed (preferred), mailed, or faxed to our office.
  • CV or Resume (Microsoft Office document iconView CV Template) A CV or resume is required to complete an adjunct faculty appointment. An optional CV template is provided for your convenience. This may be emailed (preferred), faxed, or mailed.
  • Preceptor Training Program (PDF iconView Preceptor Training Instructions) Once you receive your E*Value login information, you can access our required Preceptor Training Program. Free Continuing Education (CE) credit will be given with its completion. We require all preceptors to complete our initial training program, "Preceptor Development Core Modules". This program will provide valuable information specific to The University of Iowa College of Pharmacy Professional Experience Program.
  • Site Description (Microsoft Office document iconView Site Description Form) This form is for sites who have not previously hosted University of Iowa Pharm.D. students. The information in this form will be used to create a site description for student viewing. This helps students know what to expect when they come to your site. In addition to the information in this form, additional documents such as a syllabus, health system required forms, etc. can be uploaded to a site description. This may be emailed (preferred), faxed, or mailed.

If you have questions regarding becoming a preceptor, please contact Jackie Thompson-Oster at jacqueline-thompson-oster@uiowa.edu.