Intern Experience Affidavit Or Hours Log Page 2

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OREGON BOARD OF PHARMACY
INTERN HOURS LOG
INSTRUCTIONS: Log each day worked (LEAVING BLANK days not worked) showing number of hours worked rounded
to the nearest quarter hour (not X's). Do not put more than one calendar year on this form.
Intern name:
Year
DAY
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
SUB
Revised 06/2003
TOTAL HOURS
Page 19
Revised 6/2003

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