Your Permanent Email Address (not your school address) *
Phone *
Where do you go to pharmacy school? *
What are your career goals/post-graduation plans? *
What academic degrees you have earned? What degree(s) do you expect to earn? Where did you earn these degrees? What is your expected and/or past graduation date(s)? *
Are you a current CPA member? Please share any information about your involvement with CPA (including events you attended, committee involvement, etc.). Include any positions held and list events you attended that were not part of a school or academic requirement. *
Professional Involvement and Leadership: Please list any organizations you have been involved with in pharmacy school; please include any leadership positions you held and the dates you held these positions; please include any notable organization event or achievement you were actively involved in. *
Awards and Honors: Please list any awards and honors you received during pharmacy school (please DO NOT include Dean's List or Other Scholarships); please include the name of the award, the organization that gave you the award, the date your received the award, and the recognized activity. *
Professional Contributions: Please list any posters, publications, and presentations you have developed during pharmacy school. Please include the title/subject, the name of the journal/conference, the location, and date. *
Community Service: Please list any community service activities you were involved in during pharmacy school. Please exclude any program which is part of an educational requirement. Please include the type of service, sponsoring group, the dates, the number of hours completed, and the name and contact information of your supervisor. *
Work Experience: Please list any work experience during pharmacy school (this may include non-pharmacy work that could help prepare you for a pharmacy career; please DO NOT include IPPE and APPE rotations or other academically credited work). *
Are there other accomplishments/activities you would like to note in your application? Please list any activities not included in your application or essay (i.e. varsity or club sports, musical or other performance, RA,, etc.) *
Skills & Certifications: Please list any certifications you hold (if applicable), the certification number, date you earned the certification, and the expiration date of the certification. Please exclude any certificate obtained in pharmacy education (i.e. CPR, BLS, immunization, etc.)
Please include any additional information you would like to share that was not included in your application or essay.
Please list any personal and professional references or sponsors and their contact information. Please include: their name, title/organization, e-mail address, phone number, your relationship to them, and how long you have known them for.
