Relief Student Pharmacist Sign-up
This sign-up form is for pharmacy students who would like to be contacted when there is relief work available in Kansas. This information will be shared with companies and individuals who are seeking a pharmacist's help. If you have questions regarding the form, please call the KPhA office at 785.228.2327 or email info@ksrx.org. Thank you.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Year in School
P1
P2
P3
P4
I'm available for work in the following practice settings:
*
Hospital/Health System
Community Pharmacy
Long-term Care
Other
With which software systems are you familiar?
*
For example Cerner, QS/1, Computer Rx, etc.
By selecting YES, you acknowledge you are a Kansas-licensed pharmacy student in good standing.
*
YES
Submit
Should be Empty: