WALGREENS PHARMACY EXPERIENTIAL LEARNING APPLICATION

Please read and complete ALL portions of this form

Before applying for this externship, student must FIRST:

Be a graduate of the Pharmacy Technician Program (effective to students accepted into the program after May 1, 2012)

Apply and register with their state (if applicable) as an intern. Please review your state’s Board of Pharmacy guidelines for pharmacy technician interns. If there is not an application process to intern in your state, you may continue this application process. If there is a registration process, please complete that first. In all states where registration is required, your preceptor will ask for your registration information before placing you.

Eligibility Requirements include:

"C" average in the course (average of all tests)
Pharmacy Technician course completion (including final exam)
You have researched and learned of your state’s laws in regards to working/externing as a technician; depending on your state’s requirements, you have met all expectations

What happens to my application once it is submitted?

Upon completion of the application process, the Pharmacy Technician course instructor and Lakewood College Placement Specialist will collectively make the final decision based on the following:

Externship Application and current resume; a resume can be attached below.

Once received and approved, a student will have to sign a Liability Release prior to starting their externship.

What if I am accepted into the program? What if I am NOT accepted or there are no positions available?

If Accepted Into the Externship Program:

The Walgreens Supervisor in your area will be contacted about any opportunities that may be available. REMEMBER: Application for the program does not guarantee placement. It is solely up to each district manager at the specific location applied to, based on their needs at the time. If there are open positions, be prepared for a possible application process with them as well.

Upon acceptance, placement and completed hours, you will be required to submit your signed time sheet, reflecting the hours worked. Also,your supervisor will also be given a form to evaluate you during the externship, in which you will have to sign and submit to Career Services to finalize externship completion.

How long will I be considered for the externship?
All graduates are considered at ANY time as long as they have completed their pharmacy technician coursework and are approved graduates, meaning no outstanding balances or paperwork still needed from the school.

What will my schedule be during the externship?

Your schedule will be decided between you and your supervisor, which is based on your availability and their schedule needs. All externs are required to complete a minimum of 200 hours unless their state requires otherwise.

What if I start the application process, but decide that I no longer want to apply?

As soon as you have made this decision, please contact Career Services at 1-800-517-0857, Ext. 732 immediately with your decision.

Attendance Policy:

Student is responsible for fulfilling the schedule arranged with their pharmacy supervisor once the externship starts. If for any reason, the student cannot fulfill their scheduled time, they must notify their supervisor and Career Services IMMEDIATELY at 1-800-517-0857 x 732. If a 24-hour notice is possible, please contact the supervisor prior to the start of the scheduled shift. In the event that this is not possible, contact the supervisor as soon as possible.

For any questions or concerns regarding this application, please contact Career Serices at 1-800-517-0857 x 732.

Student Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Lakewood College Graduation Date * +

Date Available for Externship * +

Amount of Time Available for Externship Work Hours *

State Registration/License Number (if applicable)

Please attach your resume here

References

List two professional references and one personal reference (minimum one year) *

	Name	Telephone Number	Relationship & Years Known
Reference 1	Name	Telephone Number	Relationship & Years Known
Reference 2	Name	Telephone Number	Relationship & Years Known
Reference 3	Name	Telephone Number	Relationship & Years Known

Walgreens Locations Preferred

Please provide the name, address and phone numbers for 4 Walgreen's locations where you prefer to complete your externship.

	Name	Address	Phone Number
Externship Location 1	Name	Address	Phone Number
Externship Location 2	Name	Address	Phone Number
Externship Location 3	Name	Address	Phone Number
Externship Location 4	Name	Address	Phone Number

Signature

Please read and sign

I attest that I have not falsified any information on this application; I further acknowledge I am at least 18 years of age and I have completed a high school diploma or its equivalency (i.e GED). Lakewood College is committed to non-discrimination and equal opportunities in its admissions, educational programs, activities and employment regardless of race, color, creed, religion, sex, sexual orientation, national origin, age, disability or status as a disabled Vietnam-era veteran and shall take action necessary to ensure non-discrimination.

I hereby further agree to abide by all the rules and regulations that are presented by Lakewood College and the Pharmacy Experiential Learning Program.

Sign Below using your cursor. *

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