Form Asbp R 27 is a document that is used to request a reimbursement for an expense. The form must be filled out completely and accurately in order to receive reimbursement. There are specific instructions on the form that must be followed in order to ensure that the request is processed correctly. Reimbursement requests can take up to eight weeks to process, so it is important to submit the form as soon as possible. Incomplete or incorrect submissions will delay the process and may not be reimbursed.
| Question | Answer |
|---|---|
| Form Name | Form Asbp R 27 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | character voucher arizona board of pharmacy character voucher form |
Arizona State Board of Pharmacy
Physical Address: 1616 W. Adams, Suite 120, Phoenix, AZ 85007
Mailing Address: P.O. Box 18520, Phoenix, AZ 85005
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CHARACTER VOUCHER
For Full Exam or Score Transfer Applicants
For licensure candidate: ______________________________________________________
I attest to the best of my knowledge the above mentioned candidate is not addicted to the use of habit forming or narcotic drugs, is not a chronic or persistent inebriate and has not been convicted on any violation of federal or state laws pertaining to drugs or devices. The candidate is of good moral character and will in my opinion be a credit to the pharmacy profession.
I wish to add the following comments in reference for the licensure candidate:
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Pharmacist SignatureName (please print)
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AddressCityStateZip
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Pharmacist License Number |
State of Licensure |
PLEASE RETURN THIS FORM TO THE BOARD OFFICE BY MAIL, EMAIL OR FAX
Information provided on this form is for Board use only and will not be released under any circumstance
ASBP