Application 1 &2 - College of Pharmacy - Idaho State University

Dear Prospective Applicant:
We are pleased that you are considering the Non-traditional Doctor of Pharmacy (Pharm. D.) at Idaho
State University (ISU). This program offers an exciting and innovative approach designed to make it
possible for practicing pharmacists to obtain their Pharm. D. degree with the least amount of
interruption to their personal lives.
Students have up to three years to complete the didactic component of the program which includes 28
semester credit hours of course work. Didactic courses are taught using video tapes and/or detailed
syllabi, with each course utilizing a textbook suitable for the non-traditional learner. Periodically,
students may participate in a teleconference case study session with other students and their instructor.
Upon completion of the didactic courses, students are required to complete 28 weeks of clerkships.
Clerkship sites are presently being developed throughout the United States. Additional clinical sites can
be approved provided they meet the requirements specified by the faculty of the College.
We have designed a selection process which gives all candidates an equal opportunity to present
themselves. There are several components of the selection process including submission of: the
application and fee, proof of licensure, three letters of recommendation, and college / university
transcripts. After review of the application materials, selected applicants will be invited to campus for
an interview. Upon acceptance to the Non-traditional Pharm. D. program, the candidate must also be
accepted for admission to Idaho State University.
Since the number of students we accept is limited, we may not be able to place qualified candidates in
the program for the start date requested. In these cases, individuals may be placed on a ìconditional
enrollmentî waiting list and placed into the program as space becomes available.
If at any time during the selection process you have questions or concerns, please feel free to contact
our office at (208) 236-3913. Good Luck! We sincerely hope that you find the best situation for your
future success.

GUIDELINES FOR COMPLETING APPLICATION
All application materials for the Non-traditional Doctor of Pharmacy program must be sent directly to the College of Pharmacy for
processing. Please return all application materials, a photocopy or a similar proof of licensure, and the application processing fee of
$40.00 to: College of Pharmacy, Idaho State University, Campus Box 8356, Pocatello, ID 83209. (Checks should be payable to ISU,
College of Pharmacy.)
Neatness counts! We prefer that you type your application, if possible. If you must hand write the application, make sure that it is neat
and legible.
SECTION A
This information is necessary for our permanent records.
SECTION B
Residency is an important factor in our selection process; preference will be given to pharmacists currently practicing in Idaho.
Ethnicity is not a factor in the selection process and is used for statistical purposes only. If you prefer not to respond to this question,
it will not adversely affect your application.
SECTION C
Please list all colleges or universities you have attended. Include the dates that you attended the institution and whether the
institution used a semester or a quarter system and credit, points and GPA of each transcript. Request an official transcript from
each school be sent directly to the College of Pharmacy.
SECTION D
Please indicate degree(s) received, major, and when and where the degree(s) was/were received.
SECTION E
1. Only the recommendations made on the accompanying forms will be accepted. Do not send or have your references send written
letters of reference. This allows uniform evaluation of each recommendation.
2. Do not have relatives complete recommendations for you.
3. One reference must be from your current employer or supervisor. (If self-employed, have a colleague complete the recommendation.)
At least one of the two references must be from a professional colleague. The person who completes the recommendation
forms should know you well enough to comment on your strengths and weaknesses.
4. You may waive or retain your rights to have access to the evaluation. In the latter case, please have your reference send the
form directly to the College of Pharmacy. It is your responsibility to ensure your recommendations are returned by the specified
deadline.
SECTION F This is one of the most crucial components related to your selection to the Doctor of Pharmacy program.
Please provide a detailed and accurate perception of your professional practice. Please add additional pages to cover this topic area;
however please be succinct in your presentation of this material. If you feel your resume or curriculum vitae can enhance this section,
please include it.
SECTION G
Use the space provided on the back of the application to describe why you are pursuing the Doctor of Pharmacy degree, and how
you perceive this advanced degree will benefit your practice of pharmacy. Also use this opportunity to provide any other information
you feel might be useful to the Admissions Committee.
SECTION H
Your signature is your contract with the College of Pharmacy indicating that, to the best of your knowledge, all information related on
this application is accurate. False disclosure of information could disqualify your application.
ADMISSION TIME LINE
APPLICATION DEADLINE INTERVIEW DATES PROGRAM START DATE
November 1 January 1 - 31 March 1
July 1 September 1 - 30 November 1

Application For Admission To
The College of Pharmacy
Non-Traditional Doctor of Pharmacy Degree Program
Idaho State University
Pocatello, ID 83209
Please refer to “Guidelines For Completing Application”
SECTION A
Date ____________________________
Name Mr./Ms. ________________________________________________________________________________________
Any other name used while attending school? _______________________________________________________________
Permanent Home Mailing Address ________________________________________________________________________
City______________________ State ___________ Zip _____________________________
Home Phone No. (____) ________________________ Work Phone No. (____) ___________________________
(Area Code) (Area Code)
Social Security Number
________________________
Date of Birth _________________________________ Place of Birth ___________________________________
In case of emergency, please contact:
Name __________________________________ Phone (____) ___________________________________
(Area Code)
Address
__________________________________
__________________________________
Relationship to
Applicant _______________________________________
SECTION B
Residency Status:
Idaho State Resident ______ yes ______ no
If yes, how long? ________________________
Other U.S. Residents — what state?
_____________________________________________________________________
Immigrant with Permanent Residency — what state? _________________________________________________________
Other — please specify
_______________________________________________________________________________
List State(s) in which you are currently licensed to practice. (Please include a photocopy of renewal(s) with application.)
State ________________________________________
State ________________________________________
License # ______________________________________
License # ______________________________________
(OPTIONAL) Please indicate ethnic origin with which you identify:
( ) American Indian or Alaska Native ( ) Asian or Pacific Islander ( ) African American
( ) Hispanic ( ) Caucasian ( ) Other — Specify ___________________

SECTION G
Include why you are interested in pursuing the Non-traditional Doctor of Pharmacy degree. Use this opportunity to tell
the Admissions Committee anything about yourself which has not been reflected in other parts of this application. Do
not exceed the space given on this page for your essay.
SECTION H
I hereby apply for admission to the College of Pharmacy and certify that all information on this application is accurate
to the best of my knowledge. The application fee is enclosed with these documents.
Date ________________________ Signed ________________________________________________

SECTION C
Please list all higher education institutions you have attended.
College/ Dates Semester/
University Attended Quarter Credits Points GPA
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION D
Degrees Awarded:
Degree Major College/University When Completed
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION E
Recommendations
Please list the individuals from whom we will receive recommendations. It is your responsibility to ensure these individuals
return the recommendations directly to the College of Pharmacy. Please have references use the enclosed
recommendation form.
References 1 2 3
Name ________________________ ______________________ ____________________
Title ________________________ ______________________ ____________________
Business ________________________ ______________________ ____________________
Relationship
to Applicant ______________________ ____________________ ___________________
*Note: At least one reference must be from your present employer or immediate supervisor unless you are self employed.

SECTION F
Work And Professional History:
Current Position: ________________________ Date Employed: _______________
Employer:
Address:
________________________
________________________
________________________
Phone: ______________________
Summary of Duties: _________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Professional Organization Affiliations: Offices Held: Date Held:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Professional Accomplishments:
(Feel free to use additional paper.)
A) Describe in detail all practice activities and/or services in which you are or have been actively engaged and
estimate the number of hours per week involved in each (e.g., pharmacokinetic dosing, antibiotic surveillance, P & T
Committee responsibilities, health screening activities, patient counseling, administrative and dispensing function, etc.)
B) Other professional achievements (e.g., awards, presentations, significant organizational contributions, certifications,
etc.).