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Get and Sign COLLEGE of PHARMACY AFFIDAVIT 2017 Form

Get and Sign COLLEGE of PHARMACY AFFIDAVIT 2017 Form

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City State Zip Code SSN Date of Birth Email SECTION II - AFFIDAVIT TO BE COMPLETED BY THE DEAN OR AUTHORIZED PERSON OF THE PHARMACY SCHOOL AND RETURNED DIRECTLY TO THE BOARD OF PHARMACY I certify that I have read the records of and those records indicate Applicant s Full Name that the student began his/her first professional third year of study in an accredited college on the following and is eligible to become a pharmacy intern in Michigan. Month/Day/Year Signature of Dean or Authorized Person...
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