The forms and handouts section provides the downloadable forms that are needed to complete specific to immunizations and certification requirements listed in the Immunization and Certification Packet. Not all forms and handouts are required for every iPharmD student. Refer to the Immunization and Certification Packet to see what specific items are required for ITPD and NTPD students.
Address Verification Form:
Required for all ITPD and NTPD students to complete the criminal background check. Completed Address Verification Forms are to be emailed back to email@example.com or firstname.lastname@example.org.
Canadian-Criminal Record Verification Form:
The CPIC Consent form in addition to the Address Verification Form and UC Background Disclosure Form are to be completed by iPharmD students residing in Canada only. Completed forms are to be emailed to email@example.com or firstname.lastname@example.org.
Colorado Drug Testing Sites:
All students completing a site rotation in the state of Colorado are mandated by state law to complete a drug test. This handout lists locations associated with the campus and that accept walk-in as well as scheduled appointments.
CU Background Disclosure and Authorization Form:
The criminal background check stays current for two years. The background check is required upon admission but will need to be updated prior to rotations. All students will need to download and complete the CU Background Disclosure and Authorization Form and the Address Verification Form and email it via secure email to email@example.com or firstname.lastname@example.org.
By signing and uploading this document to E*Value the student acknowledges and agrees that they have read through the policies and procedures on the School of Pharmacy website and agrees to follow The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences and Distance Degrees and Programs policies and procedures throughout their participation in the program. Download this document in Forms and Handouts and sign and date once all policies and procedures are fully understood. Upload the signed form to E*Value to complete the requirement.
DORA Colorado Intern License Check List:
Students may apply online for their Colorado Intern License through Colorado Department of Regulatory Agencies (DORA). Use the intern license Checklist to start your application for a Colorado Pharmacist Intern License.
All PharmD students will need to download and sign The Family Educational Rights and Privacy Act (FERPA) Waiver. This signed form grants the Office of Experiential Programs and DDP Office the ability to confirm with the rotation site the student’s immunization records, background check information and drug test results are current and provide sites with this documentation if requested. Upload this complete document to E*Value. To read more about FERPA and student educational rights click here.
Immunization Certification-SSPPS Form:
Certifying officials are to fill out the Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) Immunization form. Refer to instructions listed on the back of the SSPPS form to be aware of what can and cannot be submitted for each immunization type. Immunization proof for the following are required: Measles, Mumps, Rubella, Hepatitis B, Polio, Tuberculin, Varicella and Influenza. Please be aware that Ministry of Health Letters are not considered acceptable forms of documentation. Upload this completed form to E*Value.
International Declaration and Authorization for Background Verification form:
In addition to the Background Disclosure and Authorization Form and the Address Verification Form, students living in countries outside the US and Canada with need to email this completed form to email@example.com.