Get Mi Lara Internship Training Affidavit 2019-2025

The MI LARA Internship Training Affidavit is a crucial document for aspiring pharmacists in Michigan, ensuring proper oversight and certification of their internship training. This guide provides clear and detailed steps to efficiently complete the affidavit online.

Follow the steps to fill out the MI LARA Internship Training Affidavit online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section I, fill out your personal information in the Applicant Information section. Type or print your first name, last name, and middle name exactly as they appear on your application.
3. Continue completing your street address, apartment or building number, city, state, and zip code. Be sure to provide your Michigan Permanent I.D. or License Number along with its expiration date.
4. Move to Section II and fill out the Site Information. Provide the name and address of the site where you completed your internship.
5. Next, enter the Preceptor Information, including the name of your supervising preceptor and their Michigan Permanent I.D. number along with the expiration date.
6. For the Preceptorship Information, indicate your internship dates (from and to), number of weeks, and hours per week for both concurrent and non-concurrent training. Keep in mind the hours limit for concurrent and non-concurrent training.
7. Complete the grid to report the approximate percentage of internship hours devoted to various training areas. Indicate if additional instruction in each area is planned.
8. Finally, both the intern and preceptor need to sign the document to certify that the information provided accurately reflects the internship experience.
9. Once all sections are filled out, save your changes, and download a copy of the affidavit. You may also choose to print or share the completed form as needed.

Complete the MI LARA Internship Training Affidavit online today to ensure your internship is certified.