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X: (302) 739-2711 WEBSITE: DPR.DELAWARE.GOV AFFIDAVIT OF INTERN EXPERIENCE INSTRUCTIONS This form is for applicants for Delaware Pharmacist licensure who completed internship hours while employed in a pharmacy business. y The applicant completes the APPLICANT INFORMATION section and sends this form to his or her supervising pharmacist. y The supervising pharmacist completes the remainder of the form, signs it in the presence of a notary and sends it directly to the Board office at the address a.

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