Date of Birth *
Mailing Address Country*
United States Of America
AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingDistrict of Columbia
Telephone Number (with area code)
Current GPA* (will be verified with official transcript)
Which Florida Pharmacy School do you attend? *
University of South FloridaNova Southeastern UniversityFlorida A & M UniversityUniversity of FloridaPalm Beach Atlantic UniversityLake Erie College (LECOM)Larkin Health Sciences Institute
What is your current academic level? *
Florida Pharmacy Foundation James A. Mincy Independent Pharmacists Scholarship - $1,000Florida Pharmacy Foundation James B. and Patsey J. Powers Scholarship - $1,000Florida Pharmacy Foundation Volusia-Flagler County Pharmacy Association Scholarship - $1,000
(Additional eligibility criteria specific to each scholarship will show when you scroll over the name of the scholarship below. CHECK/APPLY FOR ONLY TWO SCHOLARSHPS for which you meet the eligibility criteria.)
What type of pharmacy you are most likely to practice? (Please select one)
IndustryManaged CareAcademiaRetail/CommunityHospital Based/InstitutionalIndependentPharmacy Practice ManagementConsultant PharmacyNuclear PharmacyOther
Why have you chosen pharmacy as a profession? What areas of the profession interest you and why?
What are the most significant contributions you have made to your community through volunteer work?
List any pharmacy school scholastic achievements.
“List any pharmacy school scholastic achievements and honors you have earned throughout the course of your matriculation (e.g. honor society membership, scholarships, student recognition and awards, placement in competitions, Dean’s List/Semesters Honors, etc).” Character limit: 3500.
List any current involvement in professional or student offices and/organizations.
“List leadership positions and membership involvement in national, state, local, and college level organizations (e.g. officer positions, committee or council membership, appointed leadership positions, student government, etc).”Examples include Pharmacy School Treasurer of Student Body, member of Florida Pharmacy Association, member of Student Society of Health, System Pharmacy, etc. Character limit: 3500.
Please leave this field empty.
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