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ease review carefully prior to completing the application below.

APPLICATION FOR ADMISSION

Stockton University & The Ernest Mario School of Pharmacy at Rutgers University

DUAL DEGREE PHARMACY PROGRAM

This applicaon, three leers of recommendaon, the personal statement, and essay of why Stockton is your choice of undergraduate

instuon, must be submied in addion to the Stockton Applicaon for Admission (available at stockton.edu/apply). The program is

open to high school seniors only (incoming rst me freshman students) applying for admission into the dual degree program

between Stockton University and The Ernest Mario School of Pharmacy at Rutgers University. Applicaon and supplemental

documentation must be received prior to consideration for an interview with representatives from both Stockton and Rutgers.

APPLICATION FOR ADMISSION AND SUPPORTING DOCUMENTATION MUST BE POSTMARKED BY NOVEMBER 15.

Personal Informaon

___________________________________________________________________________________________________________________________________________________________________________________

last name rst middle Jr., Sr., III, etc.

___________________________________________________________________________________________________________________________________________________________________________________

other names that may appear on your academic records

___________________________________________________________________________________________________________________________________________________________________________________

address city state zip

___________________________________________________________________________________________________________________________________________________________________________________

email phone alternate (cell) phone

___________________________________________________________________________________________________________________________________________________________________________________

Social Security # date of birth

Academic Informaon

Please list all high schools aended beginning with the most recent.

school dates aended GPA degree

___________________________________________________________________________________________________________________________________________________________________________________

SAT test scores:

Evidence-Based Reading and Wring Math total (EBRW & M combined) date of test

___________________________________________________________________________________________________________________________________________________________________________________

cont.

admissions.stockton.edu • 609.652.4261 • admissions@stockton.edu

SU—APPLICATION FOR ADMISSION/DUAL DEGREE PHARMACY PROGRAM, p.2

List signicant extracurricular and/or community acvies (aach addional page(s) if necessary):

__________________________________________________________________________________________________________________________________________________________

List honors, awards or special recognions received (aach addional page(s) if necessary):

__________________________________________________________________________________________________________________________________________________________

List all employment/work experiences, internships, volunteer work, etc., for the past two years. Aach addional page(s)

if necessary:

__________________________________________________________________________________________________________________________________________________________

List names and addresses of at least three references who will be subming leers of recommendaon for you (preferably

teachers who know you well):

__________________________________________________________________________________________________________________________________________________________

Please include a personal statement (+/- 500 words) describing why you have selected this career path, your lifeme goals, and

any other relevant or addional informaon that may assist us in evaluang your applicaon while emphasizing why you wish

to enter the Stockton University/Rutgers University dual degree pharmacy program.

__________________________________________________________________________________________________________________________________________________________

Please explain why you are selecng Stockton University as the place to pursue your undergraduate educaon.

__________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________

Return this applicaon and all supplemental documentaon to:

Oce of Admissions—Dual Degree Pharmacy Program

Stockton University

101 Vera King Farris Drive

Galloway, NJ 08205-9441

admissions.stockton.edu • 609.652.4261 • admissions@stockton.edu

SU—APPLICATION FOR ADMISSION/DUAL DEGREE PHARMACY PROGRAM, p.3

Stockton University

and

The Ernest Mario School of Pharmacy at Rutgers University

CONFIDENTIALITY AGREEMENT

In order for Stockton University and the Ernest Mario School of Pharmacy of Rutgers University to

evaluate my applicaon to the Dual Degree Pharmacy Program, I (we) hereby knowingly and willingly

waive any right of access to condenal leers or memoranda of recommendaon received by

Stockton University, and further waive any right of access to leers or memoranda of recommendaon

sent or given at my request.

I (we) understand that I may request a list of persons supplying leers of recommendaon submied

to Stockton University whose names are not submied by the applicant with this applicaon.

I (we), the undersigned, have read this waiver and understanding its terms. I (we) execute it voluntarily

and with full knowledge of its signicance.

IN WITNESS WHEREOF, I (we) have signed this ________ day of _____________________, 20 ______.

________________________________________ ________________________________________

Signature (student) Signature (parent/guardian)

________________________________________ ________________________________________

Print name (student) Print name (parent/guardian)

________________________________________

Signature (witness)

________________________________________

Print name (witness)

Note: This form follows the form recommended by the State Aorney General’s Oce of New Jersey, and it

waives your rights under the Freedom of Informaon Act. Signing this waiver means that your applicaon to the

Dual Degree Pharmacy Program, including leers of reference, will be condenal.

Return this applicaon and all supplemental documentaon to:

Dual Degree Pharmacy Program

Oce of Admissions

Stockton University

101 Vera King Farris Drive

Galloway, NJ 08205-9441

admissions.stockton.edu • 609.652.4261 • admissions@stockton.edu

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SU—APPLICATION FOR ADMISSION/DUAL DEGREE PHARMACY PROGRAM, p.4

Stockton University

and

The Ernest Mario School of Pharmacy at Rutgers University

DUAL DEGREE PHARMACY PROGRAM

CONTRACT

I (we) have read and fully understand the requirements for admission to the Dual Degree Pharmacy

Program and the criteria that must be maintained in order to remain in the program. These include,

but are not limited to:

• The applicant must be a high school senior in the top 10% of his/her class and have been accepted

to Stockton University.

• Applicants must have completed 4-years of English/3-years of Science/3-years of Mathemacs

prior to being enrolled at Stockton University.

• SAT scores should be at least 1300 from the combined Evidence-Based Reading & Wring plus

Mathemacs secons. Mathemacs sub-score should be at least ≥650.

• An interview with representaves from both Stockton and Rutgers Universies will be a required

part of the admission/acceptance process.

• Students must maintain a minimum 3.0 GPA at Stockton and must have a minimum grade of ‘B’ in

each of the required courses required for entrance into EMSP. Grades of ‘B-’ are not acceptable.

• Required courses in which grades of ‘B-’ or less are received cannot be repeated to earn a higher

grade in order to remain in the program.

• The academic record of each student will be reviewed at the end of each semester while enrolled

at Stockton. Students who fail to maintain the required overall 3.0 GPA and/or earn grades of less

than ‘B’ in required courses will be dismissed from the Dual Degree Pharmacy Program. The

student will be allowed, if appropriate grades are maintained, to connue at Stockton.

• Each student must meet with their preceptor for a preliminary “grad audit” which will take place

during the student’s next to last semester at Stockton.

• An interview will be conducted by EMSP early in the student’s last semester at Stockton and prior

to nal admission to the pharmacy curriculum phase of the program.

• Students must complete an internship in the area of pharmacy while enrolled at Stockton. This

could include placement at a retail pharmacy, hospital or medical center pharmacy, or a

pharmaceucal rm.

• Students must successfully complete all pre-EMSP courses at Stockton and the four-year pharmacy

program at EMSP in order to receive the Doctor of Pharmacy degree from Rutgers University.

________________________________________ ________________________________________

Signature (student) Signature (parent/guardian)

________________________________________ ________________________________________

Print name (student) Print name (parent/guardian)

________________________________________

Date

admissions.stockton.edu • 609.652.4261 • admissions@stockton.edu

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