BOARD OF PHARMACY BOARD ELIGIBILITY APPLICATION MEETING

1. BOARD OF PHARMACY BOARD ELIGIBILITY APPLICATION MEETING

2. INTRODUCTION OF BOARD OF PHARMACY STAFF • PATRICIA EGGERS, OFFICE MANAGER • CODY WIBERG, EXECUTIVE DIRECTOR • LEEANN OLSON, OFFICE & ADMINISTRATIVE SPECIALIST SENIOR

3. ELIGIBILITY APPLICATION Full Name: Ms. Patricia A. Eggers Social Security #: 123-45-6789

4. ELIGIBILITY APPLICATION CONTINUED • Mailing Address: 2829 University Ave. SE #530, Minneapolis, MN 55414. This address is the address where you want information about your application and examination results mailed. If you move, please make sure you notify us of your new address. • Phone #: (612) 617-2201 • Current MN Intern Number: 9876

5. ELIGIBILITY APPLICATION CONTINUED • Birth Place: Terre Haute, IN • Birth Date: 3/9/1978 • Race: (Check One) ___ American Indian or Alaskan Native; ___ Asian or Pacific Islander; ___ Black, Not of Hispanic Origin; ___ Hispanic; _X_ White, Not of Hispanic Origin

6. ELIGIBILITY APPLICATION CONTINUED • Please print your name as you wish it to be engrossed on your certificate. (Please note that your name, including spaces, must be 22 spaces or less.) Patricia A Eggers (Acceptable) (17 Spaces) Patricia Ann Eggers (Acceptable) (19 Spaces) Patricia Ann Johnson-Eggers (Not Acceptable) (27 Spaces)

7. ELIGIBILITY APPLICATION CONTINUED • Are you a citizen of the United States? _X_ Yes ___ No OR • Are you a citizen of the United States? ___ Yes _X_ No • If no, what is your immigration status? (Whatever it is)

8. ELIGIBILITY APPLICATION CONTINUED • Will you have completed the required 1600 hours of internship experience, according to MN Board Rules 6800.5100 through 6800.5400, at the time of the exam for which application is being made? X Yes ___ No

9. ELIGIBILITY APPLICATION CONTINUED • Have you ever been licensed in another state as a pharmacist? ____Yes __X__No • If yes, fill in: • Where • Date of Licensure

10. ELIGIBILITY APPLICATION CONTINUED • HAVE YOU EVER BEEN CHARGED WITH VIOLATIONS OF LAWS AFFECTING THE PRACTICE OF PHARMACY? ___ YES ___ NO • If the answer is “NO”, applicant must write the following statement on the lines provided below:

11. ELIGIBILITY APPLICATION CONTINUED • “NO CHARGES INVOLVING MORAL TURPITUDE OR VIOLATION OF PHARMACY, NARCOTIC OR LIQUOR LAWS EVER MADE OR PENDING” • If the answer is “YES”, explain the charges or action that have been made or taken, on the lines provided. You may attach an additional page, if necessary.

12. ELIGIBILITY APPLICATION CONTINUED • Certification of attendance and graduation in pharmacy. Please take this application to the Office of Student Affairs for completion. Remember, the College will be getting close to 100 certification requests, so don’t wait until the last minute to turn them in.

13. ELIGIBILITY APPLICATION CONTINUED • INTERNSHIP DATA HOURS THAT HAVE BEEN SUBMITTED CONCURRENT TIME (400 HOURS MAXIMUM) - This is internship time that you worked while taking 12 or more credits.

14. ELIGIBILITY APPLICATION CONTINUED Summer Hours - You will receive hour for hour credit for these hours. Advanced Pharmacy Practice Experience - You will receive hour for hour credit for these hours. Under the current curriculum you will receive 400 hours.

15. ELIGIBILITY APPLICATION CONTINUED Other Internship Time Completed - This is fewer than 12 credit semesters, semester breaks, etc.

16. ELIGIBILITY APPLICATION CONTINUED Post Graduate Hours - You will only need to fill out this space if you still need to complete your 1600 hours.

17. ELIGIBILITY APPLICATION CONTINUED Non-dispensing Advanced Pharmacy Practice Experience – (800 hours maximum) These hours, along with your Advanced Pharmacy Practice Experience, will be sent to us by Raquel. When you total up your hours, you should have 1600 hours or more.

18. ITEMS TO SUBMIT WITH THE ELIGIBILITY APPLICATION • OFFICIAL BIRTH CERTIFICATE. A COPY OF YOUR BIRTH CERTIFICATE IS OKAY IF IT IS NOTORIZED THAT IT IS A TRUE AND EXACT COPY OF THE ORIGINAL. A COPY OF YOUR PASSPORT, THE PAGE THAT SHOWS YOUR BIRTHDATE, IS ALSO OKAY IF IT IS NOTORIZED THAT IT IS A TRUE AND EXACT COPY OF THE ORIGINAL.

19. CONTINUATION OF ITEMS TO BE SUBMITTED WITH APPLICATION • WALLET SIZE PHOTO. WALLET SIZE PHOTOS OR PASSPORT PHOTOS ARE ACCEPTED, IF IT IS A PHOTO OF JUST YOU, NO DOG, CAT, FRIEND, SPOUSE. • CHECK FOR $125. THIS CAN BE A PERSONAL CHECK. • AFFIDAVITS OF INTERNSHIP FROM ANOTHER STATE BOARD OF PHARMACY WHERE YOU DID INTERNSHIP.

20. CONTINUATION OF ITEMS TO BE SUBMITTED WITH APPLICATION • IF YOU ARE STILL DOING INTERNSHIP IN THE STATE OF MN, OTHER THAN YOUR ADVANCED PHARMACY PRACTICE EXPERIENCE, HAVE YOUR PRECEPTOR SIGN A PR/A WHEN YOU COMPLETE YOUR HOURS. • COMPLETED INTERNSHIP MANUAL

21. ITEMS THAT THE COLLEGE WILL SUBMIT TO THE BOARD • RAQUEL WILL SEND US AN AFFIDAVIT OF YOUR ADVANCED PHARMACY PRACTICE EXPERIENCE HOURS. • PETER WILL SEND US A LETTER STATING THAT YOU DID GRADUATE.

22. WHAT WILL NEED TO BE SUBMITTED AT A LATER DATE • AN OFFICIAL TRANSCRIPT, THAT SHOWS THAT YOU RECEIVED A PHARM D DEGREE, MUST BE SUBMITTED, WHEN THEY ARE AVAILABLE, IN ORDER FOR YOU TO RECEIVE YOUR PASS/FAIL LETTER.

23. WHAT YOU NEED TO MAIL TO NABP, NOT THE BRD OF PHCY • THE NAPLEX BUBBLE APPLICATION. • A CERTIFIED CHECK, MONEY ORDER, OR CASHIER’S CHECK, IN THE AMOUNT OF $465, MADE PAYABLE TO NABP. • THE MPJE BUBBLE APPLICATION. • A CERTIFIED CHECK, MONEY ORDER, OR CASHIER’S CHECK, IN THE AMOUNT OF $185, MADE PAYABLE TO NABP.

24. WHAT YOU NEED TO MAIL TO NABP, NOT THE BRD OF PHCY • MAIL THE ABOVE FOUR ITEMS TO: NABP PO BOX 1057 PARK RIDGE, IL 60068

25. WHAT TO DO • PLEASE READ YOUR NAPLEX/MPJE BOOKLET FOR DIRECTIONS THAT YOU CAN OBTAIN ON-LINE AT WWW.NABP.NET. • Click on Examination • Click on NAPLEX/MPJE • Click on the words “Download Registration Bulletin”

26. WHAT TO DO IF YOU’RE BECOMING LICENSED IN MORE THAN ONE STATE • YOU CAN APPLY TO TRANSFER YOUR NAPLEX SCORE TO PARTICIPATING STATES AT ANY TIME PRIOR TO SITTING FOR THE NAPLEX EXAM. ONCE YOU SIT FOR THE NAPLEX EXAM, YOU CANNOT TRANSFER IT. • COST OF SCORE TRANSFER IS $75 PER JURISDICTION

27. WHAT TO DO IF YOU’RE BECOMING LICENSED IN MORE THAN ONE STATE CONTINUED • YOU CANNOT TRANSFER YOUR MPJE SCORE.

28. IMPORTANT DATES • ELIGIBILITY APPLICATION – NO SET DUE DATE – DUE PRIOR TO APPROVAL GRANTED TO SIT FOR NAPLEX/MPJE EXAM • REVIEW SESSION – MAY 8, 2006 – ROOM TBA • MAY 13, 2006 – GRADUATION DATE.

29. CONTINUATION OF IMPORTANT DATES • WEEK OF MAY 15, 2006 – RAQUEL WILL SEND US AFFIDAVITS OF YOUR PHARM D ROTATIONS. • WEEK OF MAY 15, 2006 – PETER WILL SEND US CERTIFICATION OF GRADUATION.

30. CONTINUATION OF IMPORTANT DATES • WEEK OF MAY 22, 2006 – IF YOUR APPLICATION IS COMPLETE, WE WILL ADVISE NABP THAT YOU QUALIFY TO SIT FOR THE NAPLEX/MPJE EXAM. • WEEKS OF MAY 30, 2006 OR JUNE 5, 2006 – NABP WILL SEND YOU YOUR AUTHORIZATION TO TEST. IF YOU DO NOT RECEIVE THE AUTHORIZATION TO TEST, PLEASE CALL LEEANN OR PAT.

31. CONTINUATION OF IMPORTANT DATES • MAY 19, 2006 – GRADUATION DATES WILL BE POSTED ON THE TRANSCRIPTS • IF YOUR APPLICATION IS COMPLETE, TWO WEEKS AFTER YOU’VE TAKEN THE SECOND OF THE TWO EXAMS, YOU WILL RECEIVE YOUR PASS/FAIL LETTER VIA THE MAIL. • YOUR PASS/FAIL LETTER WILL NOT BE MAILED UNTIL WE RECEIVE A FINAL TRANSCRIPT.

32. OTHER INFORMATION • DO NOT CALL THE BOARD OFFICE FOR YOUR GRADES. WE WILL NOT GIVE THEM TO YOU. YOU NEED TO WAIT UNTIL IT COMES IN THE MAIL. • PLEASE CALL US IF YOU DO NOT RECEIVE A LETTER TWO WEEKS AFTER YOU TAKE YOUR LAST EXAM.

33. OTHER INFORMATION • IF YOUR APPLICATION IS NOT COMPLETE WE WILL NOT APPROVE YOU TO TAKE THE NAPLEX OR MPJE EXAMINATION. • CALL THE OFFICE (612) 617-2201, ASK FOR LEEANN OR PAT, IF YOU HAVE ANY QUESTIONS ABOUT YOUR BOARD APPLICATION.

34. THANK YOU FOR YOUR TIME.