MIDWESTERN UNIVERSITY Tomorrow s Healthcare Team

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1 MIDWESTERN UNIVERSITY Tomorrow s Healthcare Team CHICAGO COLLEGE OF PHARMACY PRE-PHARMACY ADVANTAGE PROGRAM (TRACK 2) APPLICATION COLLEGE OF DUPAGE To initiate our competitive selection process, you must complete and forward to Admissions Office, Midwestern University a TRACK 2 PRE-PHARMACY ADVANTAGE PROGRAM application packet that includes the following: A properly completed application (see Section One) Official transcripts from each high school attended and from the College of DuPage (see Section Two) A personal statement (see Section Three) Only completed application packets will be processed. SECTION ONE: APPLICATION Provide all information requested on the application form. If you prefer, you may attach a resume in lieu of completing the Employment Experiences and Extracurricular/Volunteer Community Activities section of the application. SECTION TWO: OFFICIAL TRANSCRIPTS Obtain official transcripts from all high schools attended and from the College of DuPage. Your College of DuPage transcript must include grades from courses taken during your first semester. SECTION THREE: PERSONAL STATEMENT Follow the directions in the application form for preparing your responses to essay questions. FOR MORE INFORMATION ABOUT THE PRE-PHARMACY ADVANTAGE PROGRAM VISIT TRACK 2 SUBMISSION DEADLINE DATE: JANUARY 6, 2018

2 MIDWESTERN UNIVERSITY Tomorrow s Healthcare Team CHICAGO COLLEGE OF PHARMACY PRE-PHARMACY ADVANTAGE PROGRAM (TRACK 2) APPLICATION COLLEGE OF DUPAGE Completed applications (including application, transcripts, and personal statements) should be returned to the Admissions Office, Midwestern University, st St., Downers Grove, IL no later than 1/6/18. ANTICIPATED MWU-CCP START (check one): Fall 2019 Fall 2020 PERSONAL INFORMATION: (Please type or print in black ink) Full Legal Name: Last First Middle Other Name(s) under which you may have educational records: Last First Middle Preferred or Nickname: Preferred Mailing Address (all correspondence will be sent to this address until otherwise notified): Street City State Zip Code Permanent and/or Legal Residence: Street City State Zip Code Contact Information (please place an * next to preferred contact method) Home Telephone Number Work Telephone Number Address: Area Code ( ) Area Code ( ) Gender*: Male Female Birthdate*: / / Birthplace: (city, state, country) Ethnic / Racial Origin* (check all that apply): African American/Black American Indian/Alaskan Native Asian Hispanic Nat. Hawaiian/Pacific Islands White Other/Multiple U.S. Citizen or National?* If no, indicate status and enclose documentation: YES NO Financial Application. Prior to issuing a student Visa, Midwestern University must receive documentation of sufficient financial resources to pay for education costs. Permanent Resident (Please enclose copy of your permanent resident card) Temporary Non-Citizen (F-1 visa students must complete an International Student Have you ever been convicted of a felony or misdemeanor? YES NO If yes, please explain on a separate piece of paper. Have you ever participated in the MWU, Chicago College of Pharmacy Careers in Pharmacy Summer Program? YES NO Program Date: How did you hear about MWU-CCP s Pre-Pharmacy Advantage Program? *Age, Gender, Race, Citizenship and Family Data will not used as selection criteria during the admission process. Various accrediting agencies rely on us to provide them with an accurate portrayal of our applicant pool. This data is collected for that purpose

3 FAMILY INFORMATION* (optional) Father Mother Spouse Name: Name: Name: Occupation: Occupation: Occupation: Highest Grade Level Completed: Highest Grade Level Completed: Highest Grade Level Completed: Are you related to an MWU Alumnus or Employee? YES NO EMPLOYMENT EXPERIENCES Start Mo./Yr. End Mo./Yr. # of Hours (per week, month, etc.) Place of Experience (Name, City, State) Position Title EXTRACURRICULAR AND VOLUNTEER COMMUNITY ACTIVITIES Organization Description of Role/Activity/Awards Dates/ Hrs. (per wk., mo., etc.)

4 1 st SEMESTER COLLEGE OF DUPAGE COURSE WORK Course Name Credit Hours Grade 1 st SEMESTER CUMULATIVE GPA (minimum of 3.20 is required for PPA consideration): PLANNED 2 nd SEMESTER COLLEGE OF DUPAGE COURSE WORK Course Name Credit Hours PERSONAL REFERENCES: (required) Please list the names of three individuals that know you well and would be willing to provide a recommendation on your behalf. One reference must be an educator. The other two references can be additional educators, employers or volunteer supervisors. References cannot be related to you. Name of Reference Relationship Telephone

5 PERSONAL STATEMENT: (required) Attach a response to the following questions. Please limit your response to one page per question. Please explain why you are interested in a career in pharmacy. What does empathy mean to you? Describe a personal experience where you expressed empathy. What are your plans if you are not accepted into the Pre-Pharmacy Advantage Program? SIGNATURE My signature below 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 admission or registration. Applicant s Signature Date Midwestern University provides equality of opportunity in its educational programs for all persons, maintains nondiscriminatory admissions policies, and considers for admission all qualified students regardless of race, color, sex, sexual orientation, religion, national or ethnic origin, citizenship status, disability, status as a veteran, age, or marital status. *Applicants must be able (with reasonable accommodations) to meet the technical standards as outlined in the University catalog which can be found at Before you submit this application, we suggest that you make a copy to keep for your records.

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