GAMC 2009 - 2010 Pharmacy Residency Program Application, Pharmacy Residency Program

2009 - 2010 Pharmacy Residency Program Application

Please list the colleges you have attended:
Letter of intent, application and curriculum vitae must be received at GAMC no later than January 23, 2008. Three letters of recommendation and your official transcripts must be received no later than February 23, 2008. You will be notified of the time and place for a personal interview should one be required. You may forward your transcripts and letters of recommendation to: Monica Macias, PharmD Residency Program Coordinator Glendale Adventist Medical Center 1509 Wilson Terrace Glendale, CA 91206 Phone: 818-409-8183 Fax: 818-545-1839 Email: maciasm3@ah.org Please be sure that you have registered with the ASHP Resident Matching Program by January 9, 2009 if you are applying to our Pharmacy Practice Residency.
* Indicates required information
Last Name *
First Name *
Middle Name
If you have used or been known by any other name, please give details (e.g., maiden name, etc.):
Street Address 1 *
Street Address 2 *
City *
State *
Zip *
Phone *
Cell Phone (if applicable)
E-mail Address
College 1 *
City and State *
Dates Attended *
Degree *	If Other, please specify:
College 2
City and State
Dates Attended
Degree	If Other, please specify:
College 3
City and State
Dates Attended
Degree	If Other, please specify:
Please list the last three jobs you have held. Begin with your current position.
Position 1
Organization
City and State
Date
Position 2
Organization
City and State
Date
Position 3
Organization
City and State
Date
Please list two references from whom we may expect letters of recommendation *
Letter of Intent (copy and paste here):
Curriculum Vitae (copy and paste here):
By clicking the submit button, you certify that the above information is accurate and that GAMC may obtain and use information such as references and grades from necessary sources in their evaluation of your application.

1509 Wilson Terrace â€¢ Glendale, CA 91206 â€¢ Tel: 818-409-8000