TOURO UNIVERSITY - CALIFORNIA

College of Pharmacy Supplemental Application

(Typed or Computer-Generated Only)

1. SOCIAL SECURITY NUMBER PHARMCAS ID APPLICATION FEE CONFIRMATION NUMBER

2A. LAST NAME FIRST NAME MI

2B. DO YOU HAVE ANY ACADEMIC OR LEGAL RECORDS AVAILABLE UNDER A DIFFERENT NAME WITHIN THE LAST SEVEN (7) YEARS? YES NO (If yes, please provide any additional names under which your records may appear):

3. DATE OF BIRTH / /

4A. PREFERRED MAILING ADDRESS:

STREET

CITY STATE ZIP -

4B. HAVE YOU RESIDED AT THIS ADDRESS FOR AT LEAST SEVEN (7) YEARS? YES NO (If no, please attach a seperate sheet of paper and list all of your previous addresses for the last seven years).

5. TELEPHONE () - 6. E-MAIL ADDRESS (required)

7. GENERAL DATA

-U.S. Citizen or Permanent Resident? Yes No

-Undergraduate Degree (e.g. BA, BS, BSN, etc.) Completion Date

-Undergraduate Major

-Graduate Degree Completion Date

8. HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? YES NO

(If "YES", please provide a brief explanation of the conviction on a seperate sheet of paper)

9. HAVE YOU PREVIOUSLY APPLIED TO TOURO UNIVERSITY CALIFORNIA'S COLLEGE OF PHARMACY? YES NO IF YES, DID YOU INTERVIEW? YES NO (If yes to both, attach an additional sheet of paper detailing the result of the interview(s) and what changes, if any, you have made since then which should affect a different outcome)

10. HAVE YOU EVER ATTENDED ANOTHER COLLEGE OF PHARMACY? YES NO (If yes, please attach an additional sheet of paper providing details of your enrollment, including the name of the school, term(s) of attendance, and your most recent academic standing)

11. WHAT AWARD(S) OR RECOGNITION(S) HAVE YOU RECEIVED IN THE LAST FIVE YEARS?

12. EMPLOYMENT EXPERIENCE DURING THE LAST THREE YEARS: (List in order of most recent experience)

Employer Occupation/Position Dates (mm/yy - mm/yy)

/ to /

/ to /

/ to /

13. VOLUNTEER EXPERIENCE, IF ANY, DURING THE LAST THREE YEARS: (List in order of most recent experience)

Organization Activity Dates (mm/yy - mm/yy)

/ to /

/ to /

/ to /

14. LIST YOUR FAVORITE EXTRA-CURRICULAR ACTIVITIES AND NON-ACADEMIC INTERESTS:

15. EXPLAIN WHY YOU HAVE CHOSEN TO APPLY TO OUR COLLEGE OF PHARMACY:

16. WHAT DO YOU FEEL IS THE MOST DIFFICULT CHALLENGE PHARMACISTS WILL FACE IN THE COMING YEARS? WHAT WOULD YOU DO TO OVERCOME THIS CHALLENGE?

17. PERSONAL STATEMENT - PLEASE INCLUDE, WITH YOUR APPLICATION, A RESPONSE TO THE FOLLOWING STATEMENT: (Statements should be a maximum of one full computer generated page with a minimum font size of 12. Responses may be either single or double spaced. Attach your response to your supplemental application)

The Admissions and Standards Committee reviews applications from many applicants with strong academic backgrounds and experiences. Without considering skills and accomplishments, please describe those personal characteristics you feel make you stand out as an individual.

If you require more space than that which is provided, please attach a seperate sheet of your computer generated responses to the application. Please be advised, however, that the Admissions and Standards Committee prefers shorter, concise resposnes as opposed to lengthy generalizations.

NOTICE: ALL MATERIALS SUBMITTED BY APPLICANTS BECOME THE PROPERTY OF TOURO UNIVERSITY. MATERIAL SUBMITTED BY APPLICANTS WHO ARE NOT ACCEPTED FOR ADMISSION IS DESTROYED THREE MONTHS AFTER THE CLOSE OF THE ADMISSIONS CYCLE. INFORMATION GATHERED IS USED SOLELY FOR ASSESSING APPLICANT QUALIFICATIONS AND IS NEITHER SHARED NOR TRANSMITTED OUTSIDE THE OFFICES OF TOURO UNIVERSITY.

CERTIFICATION STATEMENT: I certify that the information I have recorded in my application is correct to the best of my kowledge. I recognize that any intentional misrepresentation on my part may cause me to be denied admission or subject me to dismissal from Touro University - California's College of Pharmacy in the event I was accepted.

FULL NAME DATE / /

SIGNATURE: _________________________________

 

PARENT INFORMATION

Touro University occasionally seeks the involvement of parents in governance and advisory boards, projects of the parents network, and support. Providing this information is optional.

Student Name:

 

Fathers Name: Title of Address: (Mr., Dr., Etc.)

Preferred Phone Number: Preferred Email Address:

Home Address:

Employers Name: Employment Title:

Employers Address:

Employers Address:

Mothers Name: Title of Address: (Mrs., Dr., Etc.)

Preferred Phone Number: Preferred Email Address:

Home Address:

Employers Name: Employment Title:

Employers Address:

Employers Address: