Form LA-03 2026

The document is a registration application form for pharmacy interns issued by the Kansas State Board of Pharmacy. It outlines the necessary instructions, fees, and supplemental materials required for application submission. The form includes sections for personal information, educational background, employment plans, and personal history questions related to disciplinary actions or criminal offenses. Additionally, it requires certification from the applicant and verification from the Dean or Registrar of their pharmacy school.

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Click ‘Get Form’ to open Form LA-03 in our editor.
Begin by filling out the Applicant Information section. Enter your first name, middle name, last name, and other required personal details such as date of birth and social security number.
Proceed to the Post-Secondary Education section. List all schools attended in chronological order, including the current pharmacy school. Ensure you provide accurate dates and indicate if you graduated.
In the Employment Plans section, select whether you are currently working as a pharmacy intern. If applicable, provide the pharmacy name and contact details.
Complete the Personal History Information section by answering all questions truthfully. If any responses are 'Yes', be prepared to attach Form S-150: Personal History.
Finally, review your entries for accuracy before signing and dating the application at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2023	4.2 Satisfied (43 Votes)
2022	4.1 Satisfied (30 Votes)
2021	4.8 Satisfied (26 Votes)
2018	4.4 Satisfied (238 Votes)

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