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GRADUATE INFORMATION FORM
Fields marked with "*" are required.

Full Name:
Prefix:
First:*
Last:*
Middle:
 
Student ID Number:*
 
Parents' Name:*
 
Parents' Address:
Street:*
City:*
County:*
State:*
Zip:*
Phone Number: - -
Email Address:
 
Mailing Address Following Graduation:
Street:*
Apt./P.O. Box #
City:*
County:*
State:*
Zip:*
Phone Number:
- -
Email Address:*
Fax:
 
Degree:* Major:*
 
Relatives who attend or have graduated from USP. (Please give relationship and class year, if known).
 
High School Attended and Year Graduated:
 
List All post secondary degrees (including USP degree/s):
Degree Major Institution Name Year Received
 
If accepted into a Graduate or Professional degree program, please indicate institution and degree expected:
 
If you would like for your hometown daily and/or weekly newspapers to be notified about your graduation information, please indicate the publication(s) where a press release should be sent:
 
List activities such as memberships in professional and social organizations on campus (include office held). For example, class offices, Student Government; Dormitory Council; Fraternities; intramural athletics; etc.:
 
List academic honors, including scholarships and appointment to Deans' list (note consecutive semesters if applicable):
 
List intercollegiate athletic team membership:
 
Plans after graduation:
(a) If you will be employed full-time, please list employer's name and location and title of your position:
(b) Profession Description: (i.e., Hospital, Retail, Industry, Acute Care, Academic, PT etc.)
(c) If you will not be employed full-time, are you: (Please check one)
completing internship at
looking for a job
pursuing post graduate degree at
entering a full-time residency at
   
For statistical information, please indicate your starting salary range:
Under $25,000 $45,001 to $50,000
$25,001 to $30,000 50,001 to $55,000
$30,001 to $35,000 $55,001 to $60,000
$35,001 to $40,000 $60,001 to $65,000
$40,001 to $45,000 $65,001 to $70,000
    $70,001 and over

THIS SECTION FOR PHARMACY GRADUATES ONLY.
IF YOU ARE NOT A PHARMACY GRADUATE, PLEASE SKIP THIS SECTION.
 
Degree Received May 2007: PharmD    Flex PharmD
 
Where are you expecting to become licensed? (Check all that apply)
PA   NJ   DE   MD   Other, specify:
 
Which one of the following provides the best description of your current employment status?
1.  As of today, I have a pharmacy related position (check area below) which I will retain, or have retained, beyond my licensure as a pharmacist. (Describe only primary position, if you have more than one position)

Pharmacy Practice Pharmaceutical/
Health Industry
Other Settings
Chain Pharmacy Basic or Clinical Research College/University
Independent Pharmacy Product Development Consultant
Mail Order Pharmacy Marketing Sales, Advertising Other (specify)
Hospital/Institutional Pharmacy Drug/Medical Information
Long Term Care/Nursing Home Education/Training
Home Care, Home Infusion Medical Writing
Managed Care Regulatory
Consultant Pharmacist Other (specify):
   
2.  Because I am pursuing advanced education or training, I am currently not seeking a permanent employment position. (Check program of study below)

Residency, General or Pharmacy Practice
Residency, Specialty, Please specify specialty:
Fellowship, Please specify specialty:
Graduate and/or Professional Program (check area below)
PhD   MS or MA   MD or DO   DDS   DVM
MPH or DPH   MBA   LLD or JD   Other (Specify):
   
3. As of today, I do not have a pharmacy related position.
 
If you checked #1 or # 2, please answer the following questions:
a. What is the name of your employer?
Name :   City, State :
   
b. Which of the following best describes your major job responsibilities?
Professional or Other Staff Manager, Administrator
Owner, Entrepreneur Other (specify):
   
 
Based on your experience, how easy do you feel it was to obtain a position coming out of school?
Very easy   Easy    Somewhat easy    Not very easy
 
 

The information you have provided may be incorporated by the Deans in letters of recommendation you authorize. The Director of University Relations will also issue press releases to local papers in your area unless you instruct us to withhold the information.

Thank you for your cooperation.

Date:    Name:
 


 

 
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