Pharmacist internship training affidavit new york

Complete and submit Form 5 - Application for a Limited (Intern) Permit in accordance with instructions on the form, along with the fee of $70.

Use Form 4 - Certification of Completion of an Internship in Pharmacy to certify the completion of the required internship, which can only be performed under an authorized permit. Attach the experience log with Form 4 only if the hours are different each week. A separate Form 4 is required for each time period, for each pharmacy, and for each preceptor and should be completed, signed by both intern and preceptor, and returned to the Department at the address on the form. Pharmacy payroll records may be requested during periodic routine audits. Under no circumstance can practice during required academic rotations be counted as independent internship practice.

For calculation purposes, a week is considered a 7-day period and one month is equal to 173 hours. Credit cannot be given for any hours that exceed 40 hours per week.

The fee for a Limited (Intern) Permit is $70.

A Limited (Intern) Permit expires 5 years from the date of issue.

A Limited (Intern) Permit may be renewed once for a period of two years. The renewal fee is $70. The applicant must send:

• Fee of $70
• Form 5 - Application for a Limited (Intern) Permit Application
• Letter requesting a one time renewal

The letter must state the circumstances that have prevented the applicant from completing the requirements for licensure in NYS within the 5 year time limit of the first limited (intern) permit. This request should be sent to:

New York State Board of Pharmacy
89 Washington Ave.
2nd floor, West Wing
Albany, NY 12234-1000

A Pharmacy Limited (Intern) Permit is an official document that authorizes the practice of a profession. "Xerox copies" or duplicate photocopies of a professional license are not legal documents, therefore, only one original permit certificate is allowed. In the event that an individual is completing a clerkship and/or interning at multiple locations, it will be necessary to take the intern permit to each location for posting.

In the event that a permit is misplaced or destroyed, a replacement can be issued upon receipt of a statement, dated and signed by the intern indicating why the replacement is needed. Replacement of an intern permit is at no cost. Your request can be emailed or mailed to:

NYS Board of Pharmacy
89 Washington Avenue
2nd Floor, West Wing
Albany, NY 12234-1000
pharmbd@nysed.gov

14. I am an intern who has completed 6-months of internship before graduation. What is the deadline for applying for the Part III exam?

The deadline for applying for the January holding of the exam is November 1; For graduates of ACPE-accredited colleges of pharmacy, only candidates who will have graduated by August 31, 2015, or who have already graduated will be admitted to the June 2015 exam. No one will be admitted on the basis of 1,000 internship hours.

You will need to apply to the State Education Department (SED) to be licensed as a pharmacist. Complete and submit Form 1, along with the $339 application fee, and Form 2. Applications not submitted by the deadlines will not be considered under any circumstance.