Palm Beach County Pharmacy Association

Palm Beach County Pharmacy Association
Application for Scholarship

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

Is a resident of Palm Beach County

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.

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

Submission Deadline: February 29, 2012

Name:

E-mail:

Address:

City:

State: Zip:

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:

Were you claimed by parents 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: