Certification of Hours Completed

Advance Pharmacy Practice Experience (APPE)2016/17

Student Name:

Preceptor Name: Site Name

Module:Dates:

Type of Rotation:

Hour Requirement: 240 hours for each 6 week APPE(Total 1680 APPE hours to meet ACPE Requirements)

#hours completed (minimum 8 hours per day/5days per week – 4/10 hour days are NOT permitted)

Mon. / Tues. / Wed. / Thurs. / Friday / Hours Credited including Excused Absence / Indicate Type of Absence Using Codes Below / *Made Up Hoursas Necessitated / Total Hours
Credited/Week / Preceptor's Initials and Date, By Week
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Total Hours Credited

*Please indicate when hours were made up:

Codes for Days Student Not at Site:

H –Holidays– (mark as 0 hours)Refer to APPE Calendar,attached; Approved Holidays do not need to be made up and count as zero hours.

PL –Professional Leave – Students may request professional leave to attend professional meetings, ACPHS career day, postgraduate residency, job interviews, or State Board exams. Professional leave should not exceed 8 days per the entire P4 year and must be approved by Experiential in advance. If a student absence form is not received and approved by Experiential Education prior to taking professional leave, the time will have to be made up.

Students are allowed to attend college-sponsored professional activities, with preceptor approval on the Absence form and submitted to Experiential Education prior to the college-sponsored event, but without dipping into their 8 professional leave days. The college sponsored events would be:

1.Career Fair in November (Albany) (1/2 day)

2.Board review sessions in Albany (December or May, 2 days)

3.Legislative Day (Alb or VT)

P –Personal Day–MUST BE MADE UP andmust be cleared with Experiential Education in advance bysubmitting student absence form to our office one week prior to scheduled leave. This includes religious observance, bereavement,medical appointmentsand family illness.

I –Illness -If a student is ill and unable to attend the APPE site, the student must call or email both the site and the Experiential Education office (Ms. Jablanski) to inform all of the illness; a plan to make up the time/work missed will be determined by the preceptor and EE.

B – Bereavement – Students may request one day per rotation year for bereavement that does not need to be made up. Request for a bereavement day must be prior approved by preceptor and Experiential Education.

W –Weather - If inclement weather at any rotation location precludes a student from traveling to the site, the preceptor and the Experiential Education office should be notified and plans should be made to make up the work missed/time.

**False information on this form is considered Academic Dishonesty.**

Student Signature:Preceptor Signature:

Upload this form in CoreCompMS

FORM MUST BE SUBMITTED TO RECEIVE CREDIT FOR ROTATION

Certification of Hours Completed

Advance Pharmacy Practice Experience (APPE) – SAMPLE DOCUMENT

Student Name:Jane Student

Preceptor Name:John Preceptor Site NameOrange Pharmacy

Module:ADates:5/18-6/26/15

Type of Rotation:APPE CommunityNo. of Hours Required:240

Hour Requirement: 240 hours for each 6 week APPE(Total 1440 APPE hours to meet ACPE Requirements)

#hours completed (minimum 8 hours per day/5days per week – 4/10 hour days are NOT permitted)

Mon. / Tues. / Wed. / Thurs. / Friday / Hours Credited including Excused Absence / Indicate Type of Absence Using Codes Below / *Made Up Hours as Necessitated / Total Hours
Credited/Week / Preceptor's Initials and Date, By Week
Week 1 / 0 / 8 / 8 / 8 / 8 / 32 / H / 0 / 32 / JP 5/18/15
Week 2 / 8 / 8 / 8 / 8 / 8 / 40 / 0 / 40 / JP 5/18/15
Week 3 / 0 / 8 / 8 / 8 / 8 / 32 / S / 8 / 40 / JP 6/1/15
Week 4 / 8 / 8 / 8 / 8 / 8 / 40 / 0 / 40 / JP 6/8/15
Week 5 / 8 / 8 / 8 / 8 / 8 / 40 / 0 / 40 / JP 6/15/15
Week 6 / 8 / 8 / 8 / 8 / 8 / 40 / 0 / 40 / JP 6/22/15
232 / Total Hours Credited

*Please indicate when hours were made up:worked 8 hours Saturday, 6/20/15

Codes for Days Student Not at Site:

H –Holidays– (mark as 0 hours)Refer to APPE Calendar, attached; Approved Holidays do not need to be made up and count as zero hours.

PL –Professional Leave – Students may request professional leave to attend professional meetings, ACPHS career day, postgraduate residency, job interviews, or State Board exams. Professional leave should not exceed 8 days per the entire P4 year and must be approved by Experiential in advance. If a student absence form is not received and approved by Experiential Education prior to taking professional leave, the time will have to be made up.

Students are allowed to attend college-sponsored professional activities, with preceptor approval on the Absence form and submitted to Experiential Education prior to the college-sponsored event, but without dipping into their 8 professional leave days. The college sponsored events would be:

1.Career Fair in November (Albany) (1/2 day)

2.Board review sessions in Albany (December or May, 2 days)

3.Legislative Day (Alb or VT)

P –Personal Day–MUST BE MADE UP and must be cleared with Experiential Education in advance by submitting student absence form to our office one week prior to scheduled leave. This includes religious observance, bereavement, medical appointments and family illness.

I –Illness - If a student is ill and unable to attend the APPE site, the student must call or email both the site and the Experiential Education office (Ms. Jablanski) to inform all of the illness; a plan to make up the time/work missed will be determined by the preceptor and EE.

B – Bereavement – Students may request one day per rotation year for bereavement that does not need to be made up. Request for a bereavement day must be prior approved by preceptor and Experiential Education.

W –Weather - If inclement weather at any rotation location precludes a student from traveling to the site, the preceptor and the Experiential Education office should be notified and plans should be made to make up the work missed/time.

**False information on this form is considered Academic Dishonesty.**

Student Signature:Preceptor Signature:

Upload this form in CoreCompMS

FORM MUST BE SUBMITTED TO RECEIVE CREDIT FOR ROTATION

Advanced Pharmacy Practice Experiences

2016 – 2017 Calendar

MODULE DATES

A5/23/16 – 7/1/16

Break7/4/16 – 7/8/16

B7/11/16 – 8/19/16

C8/22/16 – 9/30/16

D10/3/16 – 11/11/16

E11/14/16 – 12/23/16

Break12/26/16 – 12/30/16

F 1/2/17 – 2/10/17

G2/13/17 – 3/24/17

H 3/27/17 – 5/5/17

VACATION/HOLIDAYS

Monday, May 30, 2016(Memorial Day)

Monday, September 5, 2016 (Labor Day)

*Monday, October 10, 2016 (Columbus Day)*

Thurs & Friday, November 24 & 25, 2016 (Thanksgiving Holidays)

*Monday, January 16, 2017 (MLK Day)*

*Monday, February 20, 2017 (Presidents Day)*

*For Columbus Day, Martin L. King Day, and President’s Day, students completing community and institutional APPEs will report to the site for duty; for other sites that are open for business on this day, students assigned to such sites are expected to report to the practice site. If the site is closed for business (or the preceptors are observing the holiday), such as some federal facilities, and the preceptor permits the student to observe the holiday, the student may take the day as a holiday…zero hours are accrued for the holiday on the certification of hours form.

GRADUATION – May 13, 2017

Revised 3/2016