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Iowa Board of Pharmacy

6200 Park Ave., Ste. 100 Des Moines, IA 50321


Petition for Waiver Form

Please review the Board's rules governing waivers 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. 

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    Contact Person for Petition for Waiver

    List each rule you are requesting to be waived (you must include the exact rule(s) or subrule(s) from 657 Iowa Administrative Code):

    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.

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    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

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    Do you wish to participate in the Board meeting when this Petition will be considered?

    Attach any relevant documentation to support your answers.

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    Sign Here

    Choose how to sign


    You will be provided with a Receipt upon submission.