School of Pharmacy Pharmacology & Toxicology Program Scholarship Application
Award
Varies
Organizations
School of Pharmacy
Deadline
04/19/2021
Supplemental Questions
Please select your program year for this coming fall.
Did you graduate from a Wisconsin public high school?
Do you feel that you are from a rural area?
Are you from Central Wisconsin?
Are you from Illinois or plan to practice in Illinois upon graduation?
Are you a first-generation college student? (A first generation student is any college student where neither parent has earned at least a 4-year (bachelor) degree.)
Click the box(es) if you have the following descent:
Are you multilingual?
What language(s), other than English, are you fluent in?
If you have Military Service; please list the branch of service, rank, and dates of service (leave blank if not applicable):
If you participate in any club sports or varsity athletics at the University of Wisconsin - Madison, please list the activity (leave blank if not applicable):
What do you plan to do immediately after completion of your B.S. Pharmacology / Toxicology degree? (If you are considering several options, select up to three choices.)
1. First Choice:
2. Second Choice:
3. Third Choice:
4. If other, please specify:
Please describe and be specific about your experience or commitment to working with historically underserved or underprivileged populations. If not applicable, please leave blank.
Please describe your future career goals including your desired area of practice (if known).
Have you participated in Pharmaceutical Sciences independent study in basic science research?
What is the average number of hours per week that you worked during the past year?
1. Summer:
2. Current Academic Year (September to present)
Describe any unique circumstances that have limited your ability to participate in extra-curricular activities.
EMPLOYMENT HISTORY: List up to 3 employment experiences you have had within the last academic year.
1. Organization/Company
2. Location (City, State)
3. Position/Title
4. Description
5. Start Date
6. End Date
7. Hours
8. Hours per
VOLUNTEER/SERVICE HISTORY: List up to 10 volunteer experiences you have had within the last academic year.
1. Organization/Company
2. Location (City, State)
3. Position/Title
4. Description
5. Start Date
6. End Date
7. Hours
8. Hours per
On average, over the past twelve months, how many volunteer/service hours per month did you complete (do not include hours completed for academic credit)? (Volunteer/service hours can be defined as activities which are not associated with the University of Wisconsin.) Please be sure that the average # hours/month is in agreement with the total (average) number of hours from your input of activities in the previous question.
STUDENT INVOLVEMENT HISTORY: List up to 10 student organizations you have participated in within the last academic year.
1. Organization/Club
2. Location (City, State)
3. Position/Title held, if any
4. Description
5. Start Date
6. End Date
7. Hours
8. Hours per
On average, over the past twelve months, how many extra curricular hours/month did you complete? (Extracurricular ca be defined as any activity completed through association with the University of Wisconsin.) Please be sure that the average # hours/month is in agreement with the total (average) number of hours from your input of activities in the previous question.
RESEARCH/PUBLICATION HISTORY: List up to 3 publications in which you have participated within the last academic year.
1. Organization
2. Research/Publication Title
3. Description
4. Publication date
POSTER/RESEARCH PRESENTATION: List up to 3 poster/research presentations in which you have participated within the last academic year.
1. Organization
2. Poster/Research Presentation Title
3. Description
4. Date of presentation
AWARDS & HONORS HISTORY: List up to five awards/honors received within the last academic year.
1. Award/Honor
Essay: Explain what you consider to be your strengths as a student and as a person.
Please indicate any special circumstances that should be taken into consideration in the review of your financial need. Please include care of others, major family illnesses, and dependents. Please be specific. Your response to this question will not be shared outside of the Scholarships Committee and will aid committee members in understanding and assessing your financial need outside of a stated FAFSA score.
