SDSU COLLEGE OF PHARMACY
2012 INCOMING P1 STUDENT SCHOLARSHIP APPLICATION
INSTRUCTION SHEET
The College of Pharmacy has scholarships available to students who have just been accepted into the
professional program. The number and dollar amounts vary from year to year. While most of the scholarships
are designated for Jackrabbit Guarantee-eligible students, at times there are some for non-JG students.
Scholarship recipients are selected after spring grades are in and are usually notified in July or early August by
mail or email. The scholarships will be presented at a program tentatively scheduled for Saturday, September
29th. Scholarship recipients are expected to attend the program. The scholarship money is typically split
between the fall and spring semesters.
In order to receive a scholarship from the College, students must complete this application. For students who
will be Jackrabbit Guarantee-eligible for 2012 – 2013, you MUST fill out the attached application even though
you have already filled out the online application.
If you will be receiving other SDSU scholarships for next year, you SHOULD fill out the attached application. It
does not often happen, but based on scholarship criteria, the College may award you a scholarship.
The criteria are varied for scholarships selected by the College of Pharmacy, thus we have a “one size fits all”
application. Application information is used only for the selection of scholarships and awards. DO NOT attach
a resume or additional materials. Please follow the directions closely.
Please TYPE in the requested information. Be sure to hit the "INSERT" key before you enter information on
the lines or use underline to maintain any necessary underlines. Unneeded underlines can be removed. Keep
the application to two pages or less by deleting any material between the two sets of asterisks not pertaining to
you. If you have questions about this application, contact:
Dr. Dan Hansen, Scholarship Co-Chair
SDSU College of Pharmacy, SAV 133
Dan.hansen@sdstate.edu
Dr. Mike Lemon, Scholarship Co-Chair
SDSU College of Pharmacy
Michael.lemon@sdstate.edu
This application is to be completed and signed and returned by (or postmarked by) May 11th, 2012, by 5:00
PM CDT to:
Ms. Sarah Vaa, Secretary
SDSU College of Pharmacy
SAV 133/Box 2202 C
Brookings, SD 57007-0099
When mailing your application, please also send an email to Sarah.Vaa@sdstate.edu so that she can track
it (on the subject line put “scholarship application”). Since the application must be signed, you cannot return it
via email.
Late applications will not be accepted.
Thank you.
Incoming P1 Scholarship Application.doc
March 2011
SDSU COLLEGE OF PHARMACY SCHOLARSHIP APPLICATION
INCOMING P1 STUDENTS
2012
Name ____________________________ _________________________ ______________ ____________________
Last
First
Middle
(Maiden)
Colleague ID# _____________________Race_________________Gender _________Date of Birth______________
Permanent (Home) Address:
_________________________________________________________________________________________________
POB/Street Address
City
County
State
Zip
Summer Mailing Address:
_________________________________________________________________________________________________
POB/Street Address
City
County
State
Zip
Phone (include Area Code): _____ _____ ______
E-mail address ______________________________________
* * *
(To keep the application to two pages, please delete material that does not pertain to you. Thank you.)
Activities: (Please check the ones in which you are/were involved and list requested information for each.)
_____ Academy of Student Pharmacists. Dates:_____________________
Offices (include dates):______________________________________________________________________________
Committees (include dates): __________________________________________________________________________
_____ American Academy of Pharmaceutical Scientists. Dates:_____________________
Offices (include dates):______________________________________________________________________________
Committees (include dates):__________________________________________________________________________
_____Kappa Epsilon. Dates: _________________________
Offices (include dates):______________________________________________________________________________
Committees (include dates):__________________________________________________________________________
____ American Society of Health-System Pharmacists (ASHP). Dates:_____________________
____ South Dakota Society of Health-System Pharmacists (SDSHP). Dates: _____________________
____ National Community Pharmacists Association (NCPA). Dates: _____________________
____ Pride of the Dakotas. Dates: _____________________
____ ROTC. Branch and dates: _____________________
____High School – If you graduated from a high school in South Dakota, please list the name of the high school and the
community in which it was located: ____________________________________________________________________
Incoming P1 Scholarship Application.doc
March 2011
____Other Activities: List organizations you have belonged to, offices held, committee assignments, and dates of all;
community activities and dates; and, non-scholarship awards and honors you have received and dates. DO NOT include
high school activities. If at another college, please include the institution’s name.
Career Objectives: Based on what you know about the profession of pharmacy at this point, check one of the following
areas of pharmacy as the one in which you think you are most likely to practice pharmacy and write a brief statement
telling of your career objectives. If you think you need more than one, do not exceed two. A “1” indicates your higher
interest at this point, #2 is your second choice.
Community ____ Hospital _____ Clinical _____ Academia ____ Industry ____ Unsure ____ Other (Specify) ____
Financial Need: Occasionally scholarships and awards criteria cite financial need as one of several criteria. Fill in the
area below with regard to your current sources of educational financing by approximating the percentage covered by the
sources listed and give your best estimate for your sources of financing for the 2011 – 2012 academic year:
2011 – 2012: ____% Scholarships/Grants ____% Loans ____% Work ____% Savings ____% Family ____% Other
2012 – 2013: ____% Scholarships/Grants ____% Loans ____% Work ____% Savings ____% Family ____% Other
If you wish to add a statement indicating financial need, please do so within the space provided below. Be specific.
Jackrabbit Guarantee ‘11-‘12: Will you be eligible? _____Yes ____No
# of Semesters _____
I attest that the information provided here is true. I also hereby authorize the SDSU Pharmacy Scholarship Committee to
obtain applicable educational information from the SDSU Registrar’s Office to complete my scholarship application. I also
allow the College of Pharmacy to provide my name, year in the program, home town, and information on organizational
activities to the scholarship’s donor(s) should I receive a scholarship.
_________________________________________________________ __________________________
Signature
Date
Incoming P1 Scholarship Application.doc
March 2011