Facts & Comparisons®
Date Submitted: ________________________
APPLICATION FORM
Wolters Kluwer Clinical Drug Information
$5,000 Drug Information Scholarship
For Postgraduate Study in Drug Information
Return to:
Wolters Kluwer
Attn: Scholarship Committee
77 Westport Plaza, Suite 450
St. Louis, Missouri 63146-3125
Applications and accompanying documents must reach Wolters Kluwer by June, 2015. Please
refer to the last page for other qualifying conditions.
For an electronic version of this application form and a poster to help promote this scholarship
on your academic site, please visit www.factsandcomparisons.com/academic-communities/.
(Please type)
Part A- Personal History
Name in Full
(last)
(first)
(middle)
Present Address
Permanent Address
Telephone Number
University/Program Attending
University/Program you will attend if not the above
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Part B- Education
Period
of Study
Name of Institution
Degree(s)
(with dates)
Major
High School
Colleges or
Universities
(Undergraduate
and Graduate)
Special Study
Submit transcripts of all undergraduate and graduate work. If the transcripts submitted with
this application do not include all final grades for your current or most recent term, you must
forward a supplemental transcript immediately upon completion of your final course work.
Part C- Accomplishments
Positions held (professional, teaching, scientific, business, other). Account for entire period
from high school graduation to date of application.
Name of Firm,
Institution, or
Organization
Title of Position
Dates
Submit curriculum vitae with the application. The information should include a summary of
academic record, degrees, and academic honors achieved; membership and activities in
professional societies; and other scholarly and professional activities.
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Part D- Program and Plans
Please address each of the following three requirements individually on separate sheets of
paper:
1) Provide a brief autobiographical sketch.
2) Provide a description of the training program that you are pursuing, with particular
reference to the drug information component. Include dates of enrollment and
anticipated completion date.
3) Provide a brief statement of your professional plans and goals. Please include:
a) Your vision of pharmacy's future and its role within the health professions
b) How you expect to contribute to this future
c) A description of your ideal position upon program completion.
Part E- References
The applicant should also have submitted on his/her behalf two letters of recommendation.
One should come from his/her major advisor, preceptor, or director of the drug information
program or other suitable reference. These letters of recommendation should confirm
the applicant's standing in a postgraduate education program and describe the scope and
duration of the drug information component of the applicant's program. Both letters of
recommendation should provide further reference to the applicant's scholarship, professional
attributes and any other factor deemed relevant to the scholarship evaluation process.
NOTE: It is the applicant's responsibility to obtain letters of reference from the persons here
named. All letters of recommendation must be received by Wolters Kluwer by June 1. Please
follow up, if necessary, to ensure a prompt reply from each reference.
Name of Reference
Position/Title
Address
1.
2.
______________________
______________________________________
Date
Signature of Applicant
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Facts & Comparisons®
SUMMARY
About the Scholarship
The $5,000 Drug Information Scholarship offered by Wolters Kluwer Clinical Drug Information
provides a $5,000 stipend to a student pursuing advanced training, specializing or with a major
emphasis, in drug information practice. The Clinical Drug Information unit of Wolters Kluwer is
composed of leading drug information applications Facts & Comparisons®, Lexicomp® and
Medi-Span®. This scholarship was established in honor of Dr. Erwin K. Kastrup, the founder of
Facts & Comparisons.
Eligibility
Applicants must be entering their final year of training in either a drug information residency
or a fellowship program with a major emphasis on drug information. The applicant must also
have earned, or will have earned, an MS or PharmD degree. For example, the typical applicant
will be starting his/her drug information residency (or fellowship) in July and will have earned
his/her PharmD or MS degree.
Application
The completed application will include the following:
1. Application Form
The completed application form will include: A brief autobiographical sketch; a
description of the training program the applicant is pursuing, with specific reference
to the drug information component; dates of enrollment and completion date; and
a brief statement of future plans and goals.
2. Curriculum Vitae
The CV should summarize previous academic record, including: Colleges attended,
degrees and academic honors achieved, membership and activities in professional
societies, and any other scholarly or professional activities.
3. Letters of Reference
The applicant should also have submitted on his/her behalf two letters of
recommendation as described in the application form.
4. Academic Transcript
A copy of a complete transcript of the applicant's academic record must be submitted.
Selection Criteria
The criteria for selection among the applicants include academic achievement, scholarly
activities and professional attributes. Selection of the scholarship recipient will be made by the
selection committee based on evaluation of the application materials and personal references.
The selection committee cannot consider any application that is incomplete, or is not
supported by all of the required data.
Award
The $5,000 scholarship will be granted upon recommendation of the selection committee.
Deadline for submission of applications is June 1. The scholarship winner will be notified by
July 1.
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