Pharmacist Form 2 - Certification Of Professional Education - New York The State Education Department Page 2
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3SECTION II : CERTIFCATION OF EDUCATION
INSTRUCTION TO SCHOOL REGISTRAR – Complete either Part A or Part B as appropriate; and Part C before returning all pages of the
completed form along with an official transcript to the Office of the Professions at the address at the end of the form.
DO NOT return this form to the applicant. This form will not be accepted if submitted by the applicant.
PART A
– ACPE OR CCAPP (Since 1993) ACCREDITED PROGRAMS
To be completed only by those schools whose pharmacy program is, or was at the time the degree was awarded, accredited by the American
Council on Pharmaceutical Education or the Canadian Council for Accreditation of Pharmacy Programs (Since 1993).
It is hereby certified that: ______________________________________________________________________________________________
(Applicant name)
is expected to receive the degree of _______________________________________________________________ on _____ / _____ / _____,
mo.
day
yr.
-or-
has earned the degree of _______________________________________________________________________ on _____ / _____ / _____.
mo.
day
yr.
PART B –
ALL OTHER PROGRAMS
(Attach an official school transcript)
INSTRUCTIONS TO THE REGISTRAR:
Complete this part only for non-accredited pharmacy programs.
1.
Please fill out the curriculum dates and length of program. Then complete items 3 and 4, checking the appropriate boxes to reflect subject areas
completed by the above named applicant. Be sure to sign and date the certification in Part C.
2.
Attach a syllabus of the course of studies completed and a catalog or brochure describing the pharmacy program, admission level and structure.
NOTE: If a catalog and syllabus were previously submitted with this form for the same class and dates as below, it is not necessary to submit additional
copies.
It is hereby certified that: ________________________________________________________________________
(Applicant name)
has satisfactorily completed all requirements for the degree as noted below.
(a)
Date of admission: _______ / _______ / _______
mo.
day
yr.
(b)
Date of completion: _______ / _______ / _______
mo.
day
yr.
(c)
Title of degree awarded: _____________________________________________
(d)
Date degree was awarded: _______ / _______ / _______
mo.
day
yr.
(e)
Length of curriculum: ________________________________________________
3.
Preprofessional Study – Please check all Content Areas covered in program.
Basic Sciences Content Area includes but is not limited to coursework in:
mathematics
biological sciences with general biology
physical sciences with general and organic chemistry
General Education Content Area includes but is not limited to coursework in each of the following areas:
social and behavioral sciences
humanities with English.
Rev. 2/16
FORM 2, PAGE 2 OF 3
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