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Iowa Board of Pharmacy

sue.mears@iowa.gov

400 SW 8th St Ste E Des Moines, IA 50309

515-281-5944

Petition for Waiver Form

Please review the Board's rules governing waivers and variances in 657 IAC Chapter 34 prior to filing a petition for waiver.  Deadline for inclusion on the Board's agenda is two weeks prior to a Board meeting. 

Address Autocomplete

    Contact Person for Petition for Waiver

    List the time period for which you are seeking a waiver. The start date must be a future date. An end date must be requested.

    Start Date

    End Date

    Have you previously requested a waiver of any of the rules listed above?

    If a prior petition for waiver was granted or denied, attach a copy of the Board's prior written ruling or correspondence.

    For each rule you are requesting to be waived, provide the following explanations:

    Have you spoken to a Board compliance officer or other member of Board staff about your request?

    Attach copies of any relevant email correspondence

    Do you plan to attend the Board meeting when this Petition will be considered?

    Attach any relevant documentation to support your answers.

    Sign Here

    Choose how to sign

    Receipt

    You will be provided with a Receipt upon submission.