Application for Scholarship

The Palm Beach County Pharmacy Association offers a yearly scholarship of $1000 to an applicant who satisfies the following requirements:

  1. Is a resident of Palm Beach County

  2. Is a full time second year of pharmacy curriculum (2P) or greater and has maintained a GPA of 2.5 (on a 4.0 system) or higher with a minimum course load of 12 credit hours.

  3. Is able to show a need for financial assistance and/or a reward for scholastic excellence.

    Submission Deadline:  March 31st 2018

Your Name (required)

Your Email (required)

Address (required)

City(required)

State(required)

Zip Code(required)

College Attending

Campus Address

Campus City

Campus State

Campus Zip

Your Daytime Phone#

Campus Phone#

Date of Birth

Marital Status:

Sex

Number of Dependents

Age of Dependents (separate by commas)


Present Status in the College of Pharmacy


Expected Date of Graduation

GPA (Pharmacy Courses)

GPA (Overall)


Father's Name

Occupation

Mother's Name

Occupation

Parents Legal Address

Size of Household

Status of Parents

Did your parents claimed you as a dependent for income tax purposes

Financial Aide Information

Scholarships or Grants
Please include title, semesters received and amount received

Loans
Please include title, semesters received and amount received

Cash Awards
Please include title, semesters received and amount received

Student Activities

Extracurricular Activities
(Name of organization, Position Held, Dates)

Honors Received
(Awards, Certificates, Dates, Etc)

Work Experience
(Employer's name, Type of work Dates, etc.)

Additional Information for Consideration