The JP Prescription Drug Awareness Foundation Scholarship About the Foundation: On September 25th 2012, our loving son, brother and friend passed away in his sleep because of the mixture of prescribed medications he was taking. The dosage of both individual medications was not lethal. What was lethal was the combination of Opiates and Benzodiazepines (anti-anxiety) medications. It was an accident; but, more importantly it was pointless and very avoidable. We are a family that has lost one of their own and now wants to do something about it. We want to help other families avoid what we have gone through. We want to help our community, city, state and nation become more aware and responsible about prescription drugs. Some basic education and awareness about the mixture of certain prescription drugs could have prevented this death. For this reason, this foundation wants to create educational programs and awareness campaigns to help reduce and even eliminate accidental deaths from prescription drugs. We also want to help improve the requirements and legislation that govern the prescription drug process. We believe that doctors should be required to disclose all possible dangers of mixing prescription drugs before prescribing them. We believe doctors should be better educated in this matter and be held more accountable. Our foundation will work to help influence political and legislative decisions regarding the rigor around the prescription drug process. Lastly, we would like to assist in the research of potentially finding safer prescription drugs that will not interact with other drugs in such a dangerous manner. This foundation has been established in JP’s name because he will constantly personify our cause. He is our driving force to make the world a safer place. This foundation is exclusively for charitable and educational purposes. Purpose: The purpose of this organization is threefold: 1) To raise awareness and education of the dangers of prescription drugs when they interact with other substances. It is our desire to educate and raise awareness with children, parents and the medical community. Accidental prescription drug interactions are creating an epidemic not widely known about. By raising awareness, we believe we can help prevent unnecessary deaths from prescription drugs. 2) To help create more rigor in the medical community as it pertains to how prescription drugs get prescribed. We want to see more legislation created to protect the consumers when being treated and prescribed drugs. 3) Research: to identify which substances that are causing the deadly interactions and how to medicate people differently to avoid a deadly dose of any prescription drug. Mission Statement: It is our mission to raise awareness and education in regards to the dangers of prescription drugs when they interact with other substances. We want to help reduce and eliminate accidental overdoses by creating educational and awareness programs and by improving the laws that regulate the prescription drug process, and by furthering research for safer prescription drugs. We want to make our community and world a safer place to live. You can learn more about our foundation on at www.jpawarenessfoundation.org 1 The JP Prescription Drug Awareness Foundation Scholarship Scholarship Information: This scholarship will be awarded to one student in the amount of $5000 to be split in one academic year: $2500 in the fall semester of 2014 and $2500 in the spring semester of 2015. This amount will be applied directly to your tuition bill from the SSPPS. The top candidates will be selected to be interviewed for the scholarship, whereas one will be chosen to be awarded the scholarship. We will contact the students selected by email to set up a time to interview, which will take place on campus prior to April 15, 2014. If for any reason the winning student has to leave the University or fails to maintain the requirements of the scholarship (as listed above), an alternate will be selected to receive the remainder of the award in his/her place. Application Instructions Applicants are asked to submit the application and all supporting documents email to Cecilia.Romero@ucdenver.edu. Please carefully review the instructions below to ensure that your application is processed without delay. APPLICATION DUE DATE: March 24, 2014 APPLICATION REQUIREMENTS: 1. Completed Application Form 2. Two Letters of Recommendation: at least one letter of recommendation must be from the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) Faculty/Advisor/Staff. 3. Statement of Intent (See detailed instructions below) 4. Resume or CV 5. SSPPS Transcript (unofficial transcript is accepted) APPLICATION FORM: Student Name: Phone Number: Mailing Address: Email Address: Cumulative Professional GPA: __ __________ Year of Graduation: ____ ______ 2 The JP Prescription Drug Awareness Foundation Scholarship Requirements of the Recipient: The following are the minimum requirements for the recipient to receive and maintain this awarded scholarship: 1. Must be a full-time student 2. Maintain a 3.0 GPA through the scholarship semester(s). 3. Maintain a “good academic standing” with no sanctions for professional or ethical conduct with the SSPPS. 4. Donate 20 hours per semester to the JP Prescription Drug Awareness Foundation Statement of Intent The Scholarship Committee considers your Statement of Intent to be an essential part of your application. Please use the pages following to respond to each of the statements. Other factors such as cumulative grade point average and pharmacy related experience are also important, but who you are, why you wish to enter the pharmaceutical profession, and how you write and think critically are major factors that committee members consider when reviewing your application. Respond openly and honestly to each section. The average statement length is approximately three to five pages; submissions exceeding seven pages are discouraged. Please number your pages and put your name in the upper right corner of each page. 3 The JP Prescription Drug Awareness Foundation Scholarship Name: A. Rationale Discuss the primary reasons for your desire to pursue your Doctor of Pharmacy (PharmD) degree. Also, discuss your primary reasons for specifically applying for this scholarship. How do you plan to be a champion for the Foundation’s cause? 4 The JP Prescription Drug Awareness Foundation Scholarship Name: B. Attributes and Liabilities Please identify your strengths, and briefly discuss any knowledge and/or skills that you might need to improve in order to successfully complete the requirements of your PharmD program. 5 The JP Prescription Drug Awareness Foundation Scholarship Name: C. Employment and Volunteer Experience Please identify and briefly discuss the relationship between your previous employment and/or volunteer experiences and your decision to pursue a PharmD. 6 The JP Prescription Drug Awareness Foundation Scholarship Name: D. Education Please discuss the relationship between your undergraduate education and your preparedness to complete the PharmD program. 7 The JP Prescription Drug Awareness Foundation Scholarship Name: E. Life Experiences Discuss how your personal experiences have led you to a career in pharmacy 8 The JP Prescription Drug Awareness Foundation Scholarship Name: F. Ethical Standards and Values Discuss how your personal values and experiences have prepared you to meet the ethical obligation of pharmacists. How do your personal values relate to the ethical obligation? What are some experiences you have had that demonstrate your willingness to fulfill this ethical obligation? Please submit your application (including all attachments) by: March 24, 2014 electronically to Cecilia.Romero@ucdenver.edu. 9