School Visit Request form
This form is for schools, educators, and organizations interested in having a Skippack Pharmacy team member speak at a career day, classroom session, or event. Looking for student shadowing or internship opportunities? Please visit our Skippack University page for more information.
School or Organization Name
School Name
*
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Website
if applicable
Your Information
Your name
*
First Name
Last Name
Your role
*
Please Select
Teacher
Guidance Counselor
Career Counselor
Administrator
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Event Details
Estimated Number of Students
*
Grade level(s). Select all that apply.
*
Middle School Students
High School Students
College / Pre-Health Students
Students exploring career options
Students interested in healthcare
Students with little to no exposure to pharmacy
Other
Type of Class or Group
*
Presentation Details
What type of experience are you looking for?
*
Career Day Presentation
Classroom Session
Small Group Discussion
Interactive Workshop
Virtual Session
Not sure — open to suggestions
Other
What topics would you like us to cover? Select all that apply.
*
What is Pharmacy? (Beyond Retail)
Careers in Healthcare
Entrepreneurship & Owning a Business
Real-World Patient Stories
Innovation in Pharmacy (Compounding, GLP-1s, Wellness Programs)
College & Career Advice
Q&A with a Pharmacist
Other
Are there any additional specific goals or topics you would like us to discuss?
Which format would you prefer?
*
In-person Visit
Virtual Presenation
Open to Either
Preferred Date(s) & Timeframe(s)
*
Final Notes
Is there anything else we should know?
Submit
Should be Empty: