IOWA BOARD OF PHARMACY EXAMINERS
400 SW EIGHTH STREET, SUITE E DES MOINES, IA 50309-4688
Phone: 515/281-5944 FAX : 515/281-4609
INSTRUCTIONS FOR FILING APPLICATION FOR EXEMPTION FROM CONTINUING EDUCATION REQUIREMENTS FOR STUDENTS ENROLLED IN HEALTH-RELATED GRADUATE PROGRAMS ONLY
The Iowa Board of Pharmacy Examiners may, in individual cases, grant exemption from Iowa continuing education requirements to pharmacists who are continuing their formal education in health-related graduate programs. Graduate program enrollment encompassing only a portion of a renewal period will not exempt the pharmacist from the continuing education requirement for the full renewal period but the requirement may be reduced commensurate with the period of enrollment.
INSTRUCTIONS:
1. Complete the application on the reverse side. Please type or print all information and be sure to complete all items.
2. The application must be filed with the office of the Iowa Board of Pharmacy Examiners at the address above prior to expiration of your current license to practice pharmacy. It is recommended that the application be filed as soon as possible following enrollment in the graduate program.
3. Incomplete applications will not be processed and will be returned to the applicant. The completed application must be supported by:
a) grade transcripts or course schedules, AND
b) a letter from the dean of the college you are attending certifying the date of enrollment and the anticipated date of completion of the graduate program.
APPLICATION FOR EXEMPTION FROM CONTINUING EDUCATION REQUIREMENTS FOR STUDENTS ENROLLED IN HEALTH-RELATED GRADUATE PROGRAMS ONLY
Please Type or Print Clearly
NAME
LICENSE #
ADDRESS CITY/STATE/ZIP
NAME OF UNIVERSITY/COLLEGE
ADDRESS OF COLLEGE
TITLE OF GRADUATE PROGRAM
DATE ENROLLED
ANTICIPATED COMPLETION DATE
BRIEF SUMMARY OF COURSE CONTENT:
SIGNATURE DATE
FOR OFFICE USE ONLY
Grade Transcript/Course Schedule _____
Letter from College Dean _____
APPROVED PERIOD______________________________________
DENIED
BOARD REPRESENTATIVE ___________________________________
DATE
