University of Hawai`i at Hilo
College of Pharmacy
Pre-Pharmacy Program
UHH Pre-Pharmacy Program Agreement
The University of Hawai’i at Hilo’s Pre-Pharmacy Program welcomes all students whether they are students at UHH or at other institutions. The Pre-Pharmacy program is a comprehensive preparatory program of study toward admittance into the College of Pharmacy at the University of Hawaii at Hilo. Completing the Pre-Pharmacy program does not guarantee admission into the Doctor of Pharmacy (Pharm.D.) Program at UHH. We offer advisory support and many great resources for students’ educational and career needs. The information requested on this form is optional and is solely intended to be used as a tool to track the progress of our Pre-Pharmacy students and to evaluate the work of our team. Please complete this agreement to the best of your ability. Completed forms can be e-mailed to: . Within 2 weeks of submitting your agreement, you will receive a welcome email with information about how to contact a Pre-Pharmacy adviser regarding your Pre-Pharmacy curriculum plan.
Personal Information (*Required)Date *
Last Name * / First Name *
UH ID Number (if applicable)
Mailing Address
City, State, Zip
Home Phone / Cell Phone
Email *
Date of Birth / Gender / Female Male
City/State/Country of Legal Residence
City/State/Country you spent the majority of your life from birth to age 18
Country of Citizenship / Visa Status (if not US citizen)
Educational Background
Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 Graduate School 1 2 3 4
Schools / Name & State / Dates Attended / Graduated? / Major/Minor Course Work
High School / From:
To: / Yes
No / N/A
College/University / From:
To: / Yes
No
Graduate or Professional / From:
To: / Yes
No
Other educational vocational schools, internship, etc. / From:
To: / Yes
No
Additional Information
Have you applied to the UHH College of Pharmacy? / Yes No If yes, when: If no, when do you expect to apply?
Have you taken the PCAT? / Yes No If yes, when: Composite percentile score?
Have you taken the UH Hilo IS-201 Pre-Pharmacy Orientation Course? / Yes No If yes, when: If no, when do you expect to sign-up?
Advising Kuleana (Responsibility)
Advising is a shared responsibility between the student and his/her adviser. The success of each student is the kuleana, or responsibility of both the student and their adviser.
Pre-Pharmacy Program Kuleana
· Help assess student’s interest in a career in Pharmacy.
· Provide support and mentorship with course planning and registration
· Offer a Pre-Pharmacy Orientation Course each spring semester (IS-201)
· Maintain confidentiality of information shared between adviser and student except for purposes of evaluating and engaging in discussions concerning the advancement of our program
Pre-Pharmacy Student Kuleana:
· Research the career of pharmacy to see if it’s a good fit
· Meet with the Pre-Pharmacy adviser at least once per semester (in person, by phone or email).
· Attend each advising session prepared and make sure to bring any relevant materials
· Take the IS 201 Pre-Pharmacy Orientation Course
· Recognize that you have the final say in your own educational decisions
Signature (*Required)
In signing this document I agree to my kuleana (responsibility) and acknowledge my role as a Pre-Pharmacy student.
Print/Type name / Date
Signature (or type initials) / Date
Please email this application to: .
Or mail to:
University of Hawai`i at Hilo
Pre-Pharmacy Program
200 W. Kawili St. Hilo, HI 96720-4091
Direct questions to: (808) 933-3162 or