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Back to Fred Wilson School of Pharmacy
Standardized Client Interest Form
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Fred Wilson School of Pharmacy
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Standardized Client Interest Form
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Last Name
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First Name
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Date of Birth
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What is your sex?
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Male
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What is your e-mail address?
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What is your home phone number?
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What is your cell phone number?
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Do you currently work for High Point University?
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If yes, what is your job title and in what department?
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Voluntary Information (not required) - Ethnicity
Voluntary Information (not required) - Height
Voluntary Information (not required) - Weight
Do you have previous experience as a Standardized Client?
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Yes
No
If you have previous experience as a Standardized Client where did you work?
Would you like us to contact you about participating as a Standardized Client in the HPU School of Pharmacy?
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Which electronic devices do you use? (such as laptop, iPad, desktop, smartphone, DVR, GPS, etc.) - List all that apply.
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Students begin their labs at 9am or 1pm. Each lab can last up to 3 hours. What times can you participate, beginning 30 minutes before the lab period begins? Please mark each time block you can participate
*
Monday 8:30 - 12:00
Monday 12:30 - 4:00
Monday 8:30 - 4:00
Tuesday 8:30 - 12:00
Tuesday 12:30 - 4:00
Tuesday 8:30 - 4:00
Wednesday 8:30 - 12:00
Wednesday 12:30 - 4:00
Wednesday 8:30 - 4:00
Thursday 8:30 - 12:00
Thursday 12:30 - 4:00
Thursday 8:30 - 4:00
Friday 8:30 - 12:00
Friday 12:30 - 4:00
Friday 8:30 - 4:00