Instructor Teaching Interest Form
First Name
Last Name
E-mail
Phone Number
Contact Address
Degree/Credentials
Teaching Topic #1
Topic #1 Teaching Options
Lecture - Pharmacotherapy
Facilitate - Small Group Activity
Facilitate - Case Discussions
Facilitate - Consultation/Clinical Skills
Interested but timing will not work this year
Teaching Topic #2
Topic #2 Teaching Options
Lecture - Pharmacotherapy
Facilitate - Small Group Activity
Facilitate - Case Discussions
Facilitate - Consultation/Clinical Skills
Interested but timing will not work this year
Teaching Topic #3
Topic #3 Teaching Options
Lecture - Pharmacotherapy
Facilitate - Small Group Activity
Facilitate - Case Discussions
Facilitate - Consultation/Clinical Skills
Interested but timing will not work this year
Want to help in other ways?
Admissions Interviews
School of Pharmacy Committees
Precepting Experiential Rotations
Comments/Notes
Optional - Attach CV/Resume
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