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PHARMACY INTERN - oregon.gov

1 Revised July 2019 APPLICATION FOR LICENSURE PHARMACY INTERN ( Expires the second November 30 from the date of issuance) APPLICATION & ELIGIBILITY REQUIREMENTS CHECKLIST: If you are enrolled or attending a PHARMACY degree program, or otherwise qualify for licensure as a PHARMACY INTERN per oregon Administrative Rules Chapter 855, Division 31: C omplete the attached License Application and submit with all of the following: An original 2 x2 passport/visa style photograph taken within the past 6 months Personal Identification Either a copy of your birth certificate AND a color copy of your state issued photo ID OR a color copy of your signed Passport.

You must respond fully and truthfully to these questions. Failure to fully and truthfully respond to these questions may result in the denial of your application or another appropriate sanction as …

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