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Scholarship Application

for Academic Year 2024-2025

Applications due by May 12, 2024

Personal Information

Name*

First Name

Last Name

E number (if currently enrolled)

Class of 2027: Please leave blank.

Professional class in academic year 2024-2025*

Email*

Address - Please click directly above "Address Line 1" to enter the 1st line of your address *

Address Line 1

Address Line 2

City

State

ZIP Code

State of legal residence*

If Tennessee, please select county of legal residence*

Date (month, year) of legal residence*

Are you currently enrolled in the MBA program or going to enroll in it?

Yes No

Are you fluent in a language other than English?*

Yes No

What other language(s) do you speak fluently?

Parents' highest level of education completed*

Were you a student athlete in high school or undergraduate?*

Yes No

Education

Primary undergraduate institution*

Will you have earned a bachelors degree by May 2023?*

Yes No

Number of undergraduate credit hours completed at ETSU:*

Pharmacy Work Experience

Do you have pharmacy work experience with any of the following employers?*

CVS Walgreens Walmart Other pharmacy No pharmacy work experience

Please name your employer:

What is/was your title with the above employer?

Length of Employment:

Community Service and Leadership Experiences

Describe your leadership experience within the community, the College, and/or the profession of pharmacy.

Describe your community service experience, particularly as it relates to pharmacy and healthcare in general.

Have you made any significant efforts toward raising awareness or educating others about cultural competency and diversity-related matters impacting the pharmacy profession?**

Yes No

**Please note that the question above is specifically related to the Walgreens Scholarships. An answer of "No" does not exclude an individual from consideration for any other scholarships.

Please describe.

Release of information*

By submitting my application, I hereby request and authorize the release of information contained in my student records at Gatton College of Pharmacy to the appropriate scholarship selection committee for the purposes of evaluation and scholarship award selection. I certify that all information in this application is complete and correct.

Thank you for your submission! Scholarship recipients will be notified of their awards in June.

Scholarship Application

for Academic Year 2024-2025

Personal Information

Education

Pharmacy Work Experience

Professional goals and pharmacy school involvement

Community Service and Leadership Experiences