Pharm.D. Supplemental Application - Fall 2009

Personal Data (Optional)

Ethnicity: African American, Non-Hispanic   Alaskan Native   American Indian   Asian or Pacific Islander   Hispanic   White, Non-Hispanic   Other

If other, please specify:

Gender: Male  Female

Residency Information

Are you a resident of Kentucky? Yes  No

Have you lived in Kentucky for the last 12 months as a non-student? Yes  No

Have you received financial support from an individual out-of-state during the last 12 months? Yes  No

Does either parent (or legal guardian) live in Kentucky? Yes  No

Have you been a student at the University of Kentucky? Yes  No

If you have been a student at UK, how many semesters, including the current (or upcoming) semester?

If you are or were recently a student at UK, do/did you pay instate tuition rates? Yes  No
Please Note: If you were previously a non-resident of Kentucky who has since been issued instate status by UK for tuition purposes, you must have the University Residency Office send a letter stating the change in your residency. The letter addressing one’s status must be received by the College of Pharmacy Office of Admissions immediately following the change in residency.

Citizenship

Birthplace:

City:

State/Province:

Country:

Are you a US Citizen?  Yes  No

If no, please list country of citizenship:

Visa: If not a US citizen, what type of Visa do you have or expect to secure?

J-1   F-1   Permanent Resident Status   Other
If other, please specify:

Is English your first (primary) language? Yes  No

If English is not primary language, please indicate TOEFL or other English proficiency exam score:

Reapplicants

Have you applied previously to the UK College of Pharmacy? Yes  No

If yes, when:     How many times?:

Have you interviewed previously with the UK College of Pharmacy? Yes  No

If yes, how many times:

If yes, please briefly describe what you have done or will be doing to enhance your application since last applying.

Legacy (Optional)

Did any of your immediate family members graduate from the University of Kentucky College of Pharmacy?
Yes  No

If Yes, please list their name (s) and relationship to you:

Admissions Qualifications

Dates you have taken or will take the Pharmacy College Admission Test (PCAT):

PCAT Date(s)    Highest Composite Percentile Score Earned:

Undergraduate Degree: BA  BS     Major:     Degree Completion Date:

Graduate Degree: MA  MS  PhD     Major:     Degree Completion Date:

Are you fluent in any language besides English? Yes  No  If yes, which language(s)?

Criminal Background Check and Drug Screen

Criminal background checks and drug screens are requirements for admission and must be completed with satisfactory results prior to matriculation at the University of Kentucky College of Pharmacy. Those applicants tentatively accepted for admission must, therefore, consent to and undergo a criminal background check and drug screen as a condition of enrollment. Existence of a conviction does not automatically disqualify an applicant from admission. Withholding information about criminal offenses and/or unsatisfactory results from a background check or drug screen may, however, result in denial of admission.

Are you currently under investigation for or have any pending adjudications against you for any law violations? Yes  No

Have you ever plead “no contest” or been convicted of a crime (please include all DUI and other drug and/or alcohol related offenses)? Yes  No

If you answered “yes” to any question above, please provide a brief explanation in the box below including. 

1. A description of each incident, including your age at the time each offense was committed
2. Specific charge(s) brought against you
3. Indicate whether misdemeanor or felony
4. Consequence(s) and/or outcome of incident(s)
   (i.e. convictions, guilty plea, guilty verdict, Alford Plea or Nolo Contendere “No Contest” plea) 
5. Reflection on incident(s), how it impacted your life and what you learned as a result

Getting To Know You

Please choose and answer three of the five short answer questions posted below. Please keep in mind this is an opportunity for you to tell us about yourself in a manner that illustrates your strengths outside the classroom. Limit responses to two or three paragraphs.

1. Tell us about a school activity, community service project, volunteer or work related experience in which your participation demonstrates evidence of activism, leadership ability or initiative. Include any unique skills, knowledge or insights you contributed or gained from participating in this activity.

2. Describe a time in which your creative efforts or outside the box thinking enabled you to solve a significant problem at school, work or in your personal life.

3. The College seeks applicants whose life experiences can contribute to a richer learning environment for our student body. Please briefly tell us about any life experiences you may have had which could contribute to the learning and broadening of perspectives for your classmates.

4. The Admissions Committee reviews applications from many applicants with strong academic backgrounds and experiences. Without considering your academic skills, honors or accomplishments, please describe the personal characteristics that make you unique or stand out as an individual.

5. Given the broad range of academic, research and leadership opportunities that exist within the College of Pharmacy, how do you plan to best represent the University of Kentucky, utilize those opportunities available here and set yourself apart from any other pharmacy student?

Disclaimer

I certify that the statements contained in this application are true, complete and correct, and I agree that said statements shall form the basis of my application. I authorize the College of Pharmacy to make any investigations that they deem appropriate and to secure any additional information concerning me. I understand that my admission and/or enrollment in the College may be revoked for presenting any false, fraudulent, or forged statements, certification or transcripts.

I have read and agree with the above statement.
I do not agree with the above statement.

Don't forget to print a copy of this completed application for your records before submitting!