Community Pharmacy Placement

Attendance Sheet
Name (as on student card): __________________________________________________________
Name (as known at placement If different from above): ___________________________________
Pharmacy Name: ___________________________________________________________________
Pharmacist Preceptor Name: _________________________________________________________
st

Year of Program: 1 Year

Accelerated

nd

Year

rd

3 Year

(please circle one above)

I hereby certify this Pharmacy student has completed the non-paid Community Pharmacy
Placement at this workplace, to my satisfaction as the Placement Preceptor.
Date

Start Time

Finish Time

No. of Hours

Pharmacist Preceptor Signature