5. White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.) APPLICATION FOR PHARMACY INTERN ATTACHMENT 1 PHARMACY SCHOOL ENROLLMENT AFFIDAVIT Name of Applicant: School of Pharmacy: Address of School: Year in School (Select one): 1 2 3 4 Expected Date of Graduation: Social Security #: STATEMENT OF PHARMACY SCHOOL ENROLLMENT ** This section must be completed by the school/college of pharmacy ** This is to certify that _________________________________________________________ NAME OF STUDENT is currently enrolled at__________________________________ School/College of Pharmacy Initial Enrollment Date: Projected Graduation Date: School Address: School Phone: SCHOOL SEAL Dean or Designee Name: Title:
5. White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.) APPLICATION FOR PHARMACY INTERN ATTACHMENT 1 PHARMACY SCHOOL ENROLLMENT AFFIDAVIT Name of Applicant: School of Pharmacy: Address of School: Year in School (Select one): 1 2 3 4 Expected Date of Graduation: Social Security #: STATEMENT OF PHARMACY SCHOOL ENROLLMENT ** This section must be completed by the school/college of pharmacy ** This is to certify that _________________________________________________________ NAME OF STUDENT is currently enrolled at__________________________________ School/College of Pharmacy Initial Enrollment Date: Projected Graduation Date: School Address: School Phone: SCHOOL SEAL Dean or Designee Name: Title: