Pharma Sciences Application 2019-2020

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

Submit Supplemental & Direct to PayPal Form

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Application for Admission to Pharmaceutical Sciences

Academic Year 2019-2020

APPLICATION

Legal Last Name*

First Name*

Middle Name

Suffix

Citizenship Status*

U.S. Citizen Legal Permanent Resident of the U.S. International Applicant

International Country*

Social Security Number

If you do not have a Social Security Number, leave the box blank. Social Security Numbers beginning with 0 will appear without the 0 at the beginning.

Other names you use or have used

First Name

Middle Name (optional)

Last Name

Suffix (optional)

Current (Mailing) Address*

Permanent Address, (if different from current address)

City

State/Province/Territory

City

State/Province/Territory

County

Zip/Postal Code

County

Zip/Postal Code

Country

Email Address*

Cell Phone Number

Home Phone Number

How did you initially learn about California Northstate University?*

*To conform to federal regulations, and to fulfill the requirements of our accrediting bodies, California Northstate University must collect aggregated student demographic information for external reporting. This information will not affect any student’s application for admission.

What is your Gender?*

Female Male Non-Binary/Third Gender TransGender Prefer Not To Say

Other:

Prefer to Self-Describe:

Date of Birth*

Place of Birth (City, State or Country)*

For governmental reporting and accreditation purposes, please indicate your race/ethnicity below or indicate that you decline to report this information.

Other, not listed above

more than one, please use | as divider

Decline to State

Are you subject to the Americans with Disabilities Act?

Yes No Decline to State

Are you the first in your family to attend graduate school?

Yes No

Native Language

Are you a foreign National?

Yes No Decline to State

Disciplinary History:

Have you ever been placed on academic probation or been found responsible for a disciplinary violation whether related to academic performance, academic misconduct, or behavioral misconduct that resulted in disciplinary action.*

Yes No

Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? [Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]*

Yes No

You answered “yes” to either or both questions, please use the space below to give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

Note: Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history

U.S. Military Information

Are you currently or have you ever been a member of the U.S. military, including active duty, National Guard, Reserves, or a Veteran discharged from military service?*

Yes No

Yes, Send a copy of your DD214 or DD295 to the College of Health Sciences for an evaluation of credit once you have submitted this application (refer to the mailing address above).

List Undergraduate Institutions Attended And Dates Attended

INSTITUTION NAME

START DATE

END DATE

Yes No

DEGREE CONFERRED

DEGREE

INSTITUTION NAME

START DATE

END DATE

Yes No

DEGREE CONFERRED

DEGREE

INSTITUTION NAME

START DATE

END DATE

Yes No

DEGREE CONFERRED

DEGREE

Overall Undergraduate GPA*

GPA Within Major

List Graduate Institutions Attended and Dates Attended

INSTITUTION NAME

START DATE

END DATE

Yes No

DEGREE CONFERRED

DEGREE

INSTITUTION NAME

START DATE

END DATE

Yes No

DEGREE CONFERRED

DEGREE

Overall Graduate GPA

Have You Completed The Following Prerequisite Courses (1yr Chemistry and 1yr Biology) or Equivalents (Applicants with a BA, BS, or Master’s Degree in Chemistry, Biology or Other related disciplines are exempt from this requirement)?

The Graduate Records Exam (GRE) is optional but encouraged. Have you taken the GRE?*

Yes No

GRE Date

GRE Verbal Reasoning Score

GRE Quantitative Reasoning Score

GRE Analytical Writing Score

Academic Distinctions

Please list any academic or educational awards and honors you received (e.g. , Dean's list, Graduated Cum Laude/Magna Cum Laude, or participation in any academic clubs, societies, or organization.)

Essay Questions

For each question, please limit your response to 400 words.

1. Why are you interested in Pharmaceutical Sciences field?*

2. What is your career goal?*

FILES

Upload a PDF of your unofficial college transcript(s). You may upload up to five transcripts using this form.*

No File Chosen