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APhA Auxiliary Pharmacy Student Scholarships - DOC

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					APhA AUXILIARY/APhA FOUNDATION STUDENT PHARMACIST SCHOLARSHIP APPLICATION FORM
The APhA Foundation, in cooperation with the APhA Academy of Student Pharmacists, offers the APhA Auxiliary/APhA Foundation Student Pharmacist Scholarships to students pursuing a career in pharmacy at an accredited college in the United States. The scholarship awards will be made in January 2010 to cover expenses associated with the Spring 2010 semester. Completed applications and supporting documents must be electronically mailed to msheahan@aphanet.org by Tuesday, December 1st, 2009.

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Name of applicant: APhA-ASP member #: Present address: Phone: Permanent address: Phone: E-mail address: Underline the mailing address you prefer: Present Permanent _________________ ______ APhA-ASP Region: ____ ____

School or College of Pharmacy you are attending (please include the full name of your school): _______________________ Anticipated date of graduation: Are you employed? If yes, how many hours do you work each week (during the school year)? Name and address of employer, if applicable: Cumulative pharmacy GPA:

Please answer the following questions to be considered for the Col. Jerry W. Ross Award: Are you currently a member of the Air Force Service? ____________ Position, if applicable: __________________________________ Do you have an immediate family member serving in the Air Force Service? ________________ Position, if applicable: __________________________________ Do you have future plans to serve with the Air Force Service? _________________ ****************************************

Name of applicant:

APhA-ASP member #:

SUPPORTING DOCUMENTS REQUIRED: CHECKLIST Check each box to attest that each item will be submitted. Incomplete applications will not be considered.
□ □ □ Student Scholarship Application Form Transcript with current GPA Essay of no more than 500 words addressing the following topic: As a future pharmacist, how do you envision your role in health care? Discussion points may include, but are not limited to: personal experiences related to patient care projects, community service programs, political advocacy, internships, work, etc. □ Letters of recommendation Letter #1 (academic) Name Title Phone E-mail

Letter #2 (non-academic) Name Title Phone E-mail □ □ Current résumé or CV List of pharmacy and non-pharmacy related activities

By submitting this application electronically to the Foundation, you are certifying that you have read and understand the conditions of the scholarship and that all the information you have provided in support of this application is complete and correct to the best of your knowledge.


				
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