Careers in Pharmacy ProgramApplication for Consideration
Directions:
- Please type in your information in the gray boxes. Use the tab key to advance to the next item.
- Upon completion, save this document to your computer, and title the document as “your name.doc” (example: John Smith.doc).
- Next, either print off your application and mail it to the CCP Dean’s Office (address below), OR attach your application document to an email, and email it to . Your subject line should begin with “CIP.”
- Arrange for a copy of your official high school transcript, which includes your high school ranking and cumulative grade point average, to be sent to the Dean’s Office address below.
All items must be postmarked by
March 15, 2015, and sent to:Midwestern University
Chicago College of Pharmacy, Dean’s Office
Attn: Ms. Cheryl Elder
555 31st Street
Downers Grove, IL 60515
This program runs from July 6th thru 31st. If you have questions while completing the application, contact
Ms. Cheryl Elder, Dean’s Office, Chicago College of Pharmacy, 630-971-6417 or or .
You will be notified if you are selected for a brief interview to be conducted via telephone. Interview times will
be coordinated in advance for a mutually agreed-upon time. You will be notified of a final decision regarding admittance into the program no later than May4, 2015. If accepted into the program, the Program Director will assign you to a Walgreens location near your home for that portion of the program. There will also be applicants placed on a wait list, should any accepted students turn down their invitation to participate in the program.
Accepted students must:
- Complete the supplemental forms (included with the acceptance letter) and return them by the due date indicated.
- Apply for and obtain a pharmacy technician license. To obtain or download a license application, contact the Department of Financial and Professional Regulation (IDFPR, phone 217-785-0800, or website To apply for a license, you will need to submit an application and a $40 fee to the IDFPR.
- Arrange for their own transportation to the Chicago College of Pharmacy campus in Downers Grove and to their assigned pharmacy sites.
TRAVEL SCHOLARSHIP: For selected participants, it is important to note that transportation will be the responsibility of the participant. This includes both transportation to the Midwestern University campus in Downers Grove (for 11 days), as well as to the assigned Walgreens site (for 9 days), which can be arranged to be closer to home. For some families, this transportation cost may be a more significant expense. As such, we will be awarding five travel scholarships of $500 each to assist with these expenses (ie – gas, rental car, mass transit/cab, etc.).
Scholarships will be awarded based solely on both the distance to be traveled to the Downers Grove campus
from the home address, as well as median household income for the home zipcode (according to the U.S. Census Bureau’s statistics from the 2010 census, available at Eligible recipients will be determined by a committee independent of the participant admission committee. Notification to scholarship awardees will be made in the program’s acceptance letter.One scholarship per household.
Careers in Pharmacy Program
Application for Consideration
PERSONAL INFORMATION
Name: ,
Last First Middle
Mailing Address:
Street
,
CityStateZip Code
Home Telephone:() Cell Telephone:()
Email address:
Birthdate:* (Must be age 16 to obtain a pharmacy technician license.)
Do you anticipate graduating high school with the Class of 2016? Yes No
(This program is only available to students who are in their junior year of high school.)
Gender:* Male Female
Race or Ethnic Origin:*
White (Non Hispanic) American Indian or Alaskan Native
Black (Non Hispanic) Hispanic
Asian or Pacific Islander Other:
U.S. Citizen or National? Yes No
If you checked no, indicate status and enclose documentation:
Permanent Resident Eligible Non-Citizen Temporary Non-Citizen
Have you ever been convicted of a felony? Yes No
If yes, please explain:
Has any formal disciplinary action been taken against you? Yes No
If yes, please explain:
FAMILY INFORMATION* (optional)
1
Father
Name:
Phone:
Occupation:
Mother
Name:
Phone:
Occupation:
1
Are you related to an MWU alumnus/employee? Yes No
If yes, who?
Relationship:
EXTRA-CURRICULAR, VOLUNTEER, EMPLOYMENT ACTIVITIES
In order of significance, list the extra-curricular, community/volunteer, and/or employment activities in which you have participated in since beginning high school. Please describe the organization’s objective (if not apparent) and your duties/role,
identify any leadership or position(s) held, awards or honors achieved, significant
events undertaken and your particular role, and/or any additional distinctions earned
or contributions made while participating in these activities. The Description should be at least a few sentences in length.
Organization:
Dates:
Description:
Organization:
Dates:
Description:
Organization:
Dates:
Description:
Organization:
Dates:
Description:
Organization:
Dates:
Description:
Organization:
Dates:
Description:
Organization:
Dates:
Description:
ACADEMIC INFORMATION
High School Attending:
Location (city, state):
Attendance Dates:
(if applicable)
Previous High School Attended:
Location (city, state):
Attendance Dates:
PERSONAL STATEMENT (REQUIRED):
Please write a brief statement (no more than 250 words).
Please explain why you believe pharmacy may be a good career choice for you.
SIGNATURE/ATTESTMENT (REQUIRED):
My signature below (or typed-in name, if submitting electronically) indicates that all information contained in this application is factually correct and complete. I understand that the misrepresentation or omission of application information is sufficient grounds for canceling my participation in this program.
Applicant’s Signature:
Date:
Midwestern University considers for admission those students who possess the academic and professional promise necessary to become outstanding health professionals. The University does not discriminate on
the basis of sex, age, race, color, national and ethnic origin, sexual orientation or disability.
Applicants must be able (with reasonable accommodations) to meet the technical standards as outlined
in the University catalog:
Before you submit this application, we suggest that you make a copy to keep for your records.
1