Document 6574335

 For office use only: Date received: Check number: Initial: Deposit: 100000 2505 51030 205 AY 1415 Drake University Doctor of Pharmacy (PharmD) Supplemental Application Our application deadline for fall 2015 admission is Monday, December 1, 2014 (Wednesday, October 1, 2014 for Drake Pre-­‐Pharmacy students). All admission materials, including your PharmCAS application (www.pharmcas.org), this supplemental application and the accompanying $70.00 application fee, must be postmarked by this date. Applications without all three components will be considered incomplete and will NOT be considered for admission! Directions: Please complete all sections and print this form. Attach a check or enter your credit card information below for the $70.00 supplemental application fee and mail directly to: Drake University Cashier’s Office 2507 University Ave. Des Moines, IA 50311 Payment Information Please select your payment type: ☐ check # If paying by credit card, please enter your card information. Credit Card Number: Signature: ☐
■ credit card Expiration Date: / Personal Information Last Name: First Name: Middle Init: Date of Birth: PharmCAS ID: Current Mailing Address: City: State: Zip Code: Email Address: Primary Phone Number: Please list any additional names you have used for legal documentation in the past: ☐ yes ☐ no Are you a U.S. citizen or permanent resident? If you are not a U.S. citizen or permanent resident, what is your current status? ☐ yes ☐ no Have you ever been convicted of a felony or misdemeanor? (If you answered “yes,” please attach a separate letter explaining the nature of your conviction.) 1 Drake University Doctor of Pharmacy (PharmD) Supplemental Application NOTICE: As part of the admission process, all admitted students are required to complete a criminal background check through PharmCAS. Are you a certified pharmacy technician? ☐ yes ☐ no Drake Legacy: Please provide the following information for any parent, grandparent or great-­‐grandparent who has earned a degree from Drake University. Be sure to include both the current name and the name at the time the degree was earned for each individual. Full Name Full Name at Time of Degree Graduation Date (mm/yyyy) Drake ID (if known) Relationship to You Academic Information Are you currently enrolled in the Drake University PharmD Difference (Pre-­‐Pharmacy) program? ☐ yes Have you ever attended Drake University? ☐ yes ☐ no If you answered “yes,” please provide the dates you attended: to ☐ no (If currently attending, write “current” on the second line. Please check the box for any degrees you have earned or expect to earn by May 2015: ☐ Associates ☐ BA/BS ☐ Master ☐ Doctorate/PhD ☐ Other: Community College students only: Do you hold an active Phi Theta Kappa membership? Current cumulative GPA: ☐ yes ☐ no (Please calculate one GPA that includes courses from every institution you have attended.) Pharmacy College Admission Test (PCAT) When did you take your most recent PCAT? (If you have not taken the PCAT, list the date you intend to take the exam.) What is your highest PCAT score? (Please list the Composite Percentile score only.) ☐ yes ☐ no Do you intend to take the PCAT again? If you answered “yes,” list your next anticipated test date: International Transcripts If you are currently attending, or have ever attended, a non-­‐U.S. college or university, please visit http://tinyurl.com/internationaltranscripts for instructions on how to submit your international transcripts. Please do NOT send international transcripts directly to Drake University unless specifically requested. Are you currently attending, or have you ever attended, a non-­‐U.S. college or university? ☐ yes ☐ no 2 Drake University Doctor of Pharmacy (PharmD) Supplemental Application Please provide the following information for all non-­‐U.S. colleges or universities you have attended: College or University Name Attended From (mm/dd/yyyy) City and Country Attended To (mm/dd/yyyy) Transcript Information PharmCAS must receive all official transcripts from colleges or universities within the United States no later than Monday, December 1, 2014 (Wednesday, October 1, 2014 for Drake Pre-­‐Pharmacy students). Please do NOT send transcripts directly to Drake unless specifically requested. The chart below lists the prerequisite courses required for admission into the Drake University PharmD program. Please read this chart carefully to determine if you have fulfilled the requirements and complete the table according to your transcript information. If a course has not yet been completed, indicate the date you will complete it in the “Date Completed” column. (Drake University reserves the right to request course descriptions and/or syllabi for review before accepting prerequisite coursework.) Biological Sciences – 8 credits required, including labs (must complete by end of spring term prior to enrollment) A complete year course sequence in the principles of biology (which may include ecology, evolution, anatomy/physiology or animals, cell biology, heredity, biological diversity and the structure of plants and animals) is required. Biology courses must include lab components. Follow the recommended biology course sequence for pre-­‐medicine. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed General (Inorganic) Chemistry – 8 credits required, including labs (must complete by end of spring term prior to enrollment) A complete year course sequence in general or inorganic chemistry is required. Chemistry courses must include lab components and must fulfill the prerequisite requirements for organic chemistry. Common course titles include Fundamentals of Chemistry I and II or General Chemistry I and II. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed Organic Chemistry – 8 credits required, including labs (must complete by end of spring term prior to enrollment) A complete year course sequence in organic chemistry is required. Organic chemistry courses must include lab components. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed 3 Drake University Doctor of Pharmacy (PharmD) Supplemental Application Microbiology – 3 credits required (must complete by end of spring term prior to enrollment) A general one-­‐semester course in microbiology is required. A lab component is not required. This should be a course intended for healthcare majors. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed Calculus – 4 credits required (must complete by end of spring term prior to enrollment) A one-­‐semester course in calculus (which may include functions, continuity, limits, techniques of differentiation, applications of derivatives, definite integrals, techniques of integration, applications of definite integrals, infinite series, plan curves, continuity and differentiation for functions of several variables and multiple integrals) is required. Business calculus courses or calculus courses designed for social sciences will NOT be accepted. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed Statistics – 3 credits required (must complete by end of spring term prior to enrollment) A general one-­‐semester course in statistics (which may include distributions, relationships between variables, design of samples and experiments, probabilities and probability distributions, significance tests associated with means and proportions, two-­‐way tables and one-­‐way ANOVA) is required. Business and psychology statistics courses WILL be accepted. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed English Writing/Composition – 6 credits required (must complete by end of summer term prior to enrollment) A complete year course sequence in college-­‐level English writing or composition is required. This sequence could be made up of a one-­‐semester college-­‐
level composition course and a one-­‐semester intensive writing course. Common course titles include Composition I and II. *Current Drake students may use their First-­‐Year Seminar and their Written Communication AOI for this sequence. **Admitted students must contact the Drake University College of Pharmacy and Health Sciences for approval if the English Writing/Composition requirement will not be completed by the end of the spring term prior to enrollment. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed Public Speaking – 3 credits required (must complete by end of summer term prior to enrollment) A one-­‐semester course that focuses on public speaking is required. Common course titles include Fundamentals of Speaking and Public Speaking. Interpersonal speaking and communication courses will NOT be accepted. ***Admitted students must contact the Drake University College of Pharmacy and Health Sciences for approval if the Public Speaking requirement will not be completed by the end of the spring term prior to enrollment. Name of College or University Course # Course Title Credits Earned Grade Earned Date Completed Acknowledgement and Signature By signing below, I indicate that I have read each area of this supplemental application form and that all foregoing information is true and complete to the best of my knowledge. I understand that this form is a supplement to, and DOES NOT replace, the required PharmCAS application. My Signature also indicates that to the best of my ability, I believe I have satisfied all prerequisites for entry in Drake University’s Doctor of Pharmacy (PharmD) program in the Collage of Pharmacy and Health Sciences, or that I have a plan to complete all prerequisites prior to the deadlines indicated in this form. Applicant Signature: Date: 4