BOARD OF PHARMACY BOARD ELIGIBILITY APPLICATION

MEETING

INTRODUCTION OF BOARD OF PHARMACY STAFF

Patricia Eggers, Office Manager Cody Wiberg, Executive Director LeeAnn Olson, Office & Administrative

Specialist Senior

ELIGIBILITY APPLICATIONFull Name: Ms. Patricia A. Eggers

Social Security #: 123-45-6789

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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 #: (651) 201-2825 CURRENT MN INTERN NUMBER: 809876

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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

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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)

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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)

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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

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Have you ever been licensed in another state as a pharmacist? ____Yes __X__No

If yes, fill in: Where Date of Licensure

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HAVE YOU EVER BEEN CHARGED WITH VIOLATIONS OF LAWS AFFECTING THE PRACTICE OF PHARMACY OR HAVE YOU EVER BEEN DISCIPLINED BY ANY HEALTHCARE LICENSING BOARD OR AGENCY? ___ YES ___ NO

If the answer is “NO”, applicant must write the following statement on the lines provided below:

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“No charges involving moral turpitude or violation of pharmacy, narcotic or liquor laws ever made or pending and no discipline by any healthcare licensing board or agency received 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.

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Certification of attendance and graduation in pharmacy.

Please take this application to the Office of Student Affairs for completion.

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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.

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SUMMER HOURS - You will receive hour for hour credit for these hours.

INTRODUCTORY OR ADVANCED PHARMACY PRACTICE EXPERIENCE - You will receive hour for hour credit for these hours. Under the current curriculum you will receive 440 hours minimum.

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OTHER INTERNSHIP TIME COMPLETED - This is fewer than 12 credit semesters, semester breaks, etc.

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POST GRADUATE HOURS - You will only need to fill out this space if you still need to complete your 1600 hours.

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NON-DISPENSING OR 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.

ITEMS TO SUBMIT WITH THE ELIGIBILITY APPLICATION

OFFICIAL BIRTH CERTIFICATE. A copy of your birth certificate is okay if it is notarized that it is a true and exact copy of the original. A copy of your passport, the page that shows your birth date, is also okay if it is notarized that it is a true and exact copy of the original.

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.

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 for the hours you have left to complete.

COMPLETED INTERNSHIP MANUAL

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.

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.

WHAT YOU NEED TO DO TO SIT FOR THE NAPLEX & MPJE EXAM

Go to the web site for NABP – www.nabp.net. Click on “Programs” on the top menu bar. Click on NAPLEX or MPJE after their symbols. Click on “Registering for the NAPLEX” or

“Registering for the MPJE” on the left side of the screen.

WHAT WILL THIS COST ME

The NAPLEX examination costs $485. The MPJE examination costs $200. The Registration Bulletin will give you many

instructions. You can view or print this by clicking on “Registration Bulletin” in the left menu.

There is also a “Pre-NAPLEX” that you can click on in the left menu.

SCHEDULING AN APPOINTMENT TO TAKE THE EXAMINATION

You can also confirm or schedule an appointment to take your examinations on-line. Click on “Schedule Your Exam” under either NAPLEX or MPJE.

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 the score.

It will cost $75 per jurisdiction to transfer your score.

WHAT TO DO IF YOU’RE BECOMING LICENSED IN MORE THAN ONE STATE CONTINUED

You cannot transfer your MPJE exam score.

IMPORTANT DATES

ELIGIBILITY APPLICATION – No set date that it is due but approval to sit for the NAPLEX/MPJE exam eligibility will not be granted until we receive it.

REVIEW SESSION – May 2, 2011 – Noon – Mayo Auditorium

May 14, 2011 – Graduation Date.

CONTINUATION OF IMPORTANT DATES

Week of May 16, 2011 – Externship Coordinator will send us affidavits of your APPE rotation.

May 16, 2011 or later – Office of Student Affairs will send us certification of graduation.

CONTINUATION OF IMPORTANT DATES

Week of May 23, 2011 – If your application is complete, we will advise NABP that you qualify to sit for the NAPLEX/MPJE exams.

Weeks of May 31 or June 6, 2011 – NABP will e-mail you your authorization to test. If you do not receive the authorization to test, please call LeeAnn or Pat.

CONTINUATION OF IMPORTANT DATES

MAY 30, 2011 – 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.

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.

OTHER INFORMATION

If your application is not complete we will not approve you to take the NAPLEX or MPJE examinations.

Call the office (651) 201-2825, ask for LeeAnn or Pat, if you have any questions about your board application.

THANK YOU FOR YOUR TIME.