Follow the steps to complete your affidavit with ease.

1. Press the ‘Get Form’ button to obtain the document and access it in an editable format.
2. Begin by filling out Section I, which requires your applicant information. Enter your first name, middle name, last name, street address, apartment or building number, city, state, and zip code. Include your Michigan Permanent ID or license number and its expiration date.
3. Next, send the partially completed form to your Pharmacist Preceptor for completion of Section II. The Preceptor will need to add site information, including the site name, address, city, state, and zip code.
4. In the Preceptor Information section, the Preceptor should enter their name along with their Michigan Permanent ID number and expiration date.
5. In the Preceptorship Information section, differentiate between concurrent and non-concurrent training by filling in the dates of your internship and externship, the number of weeks, hours per week, and total hours for each.
6. Indicate the approximate percentage of hours devoted to training in each specified area, as listed in the grid provided. Also, state whether additional instruction in these areas is indicated and planned.
7. Ensure that both the Preceptor and the Intern sign the form to certify that the provided information accurately reflects the internship experience.
8. Finally, once the form is completed and all signatures are obtained, you can save your changes, and download, print, or share the form as required.

Complete your MI LARA Internship Training Affidavit online today to ensure your certification process is smooth and efficient.