Please Note: In the long answer boxes below, please hit enter twice to ensure that your paragraphs remain separate. Check the box(es) for the Site(s) to which you are applying:
Rockingham County Council on Aging and Carolina Apothecary - Reidsville
Moose Professional Pharmacy - in cooperation with Charlotte Area Health Education Center
Kerr Health Care Center – Chapel Hill
Kerr Health Care Center – Raleigh
Kerr Health Care Center – Zebulon
Upload this application form containing a statement of your career goals and reasons for pursuing a Community Pharmacy Residency and your resume or curriculum vitae no later than January 1. In order for your application to be complete, your transcript and three letters of recommendation with the personal reference form need to be mailed or emailed to the address below no later than January 1.
1. Applicant's name in full:
(Last) (First) (Middle)
2. Address and telephone:
(Number and Street) (Telephone Number)
(City) (State) (Zip) (Country)
E-mail address:
3. Citizenship: USA Other Type Visa
If items 4-10 are included in your CV, please state "See CV" in the answer fields provided.
*4. Colleges (list all attended, last one first)
College(s) attended, location(s), date(s) of attendance, and degree(s) awarded:
*5. Extracurricular Activities
*6. Honors, Awards and Distinctions
*7. Memberships/offices and activities in professional associations
8. A) States in which you are licensed to practice pharmacy
B) If not currently licensed, when and in what state(s) will you take the licensing examination?
*9. List in chronological order your pharmacy employment, internship and clerkship experience, including dates names of pharmacist preceptors.
10. Have you ever been arrested or convicted of any violations of the law that would preclude licensure? If yes, please explain.
*11. List the name, phone number, street address, and email address of the three persons whom you have requested submit a letter of recommendation and personal reference form.
Reference 1:
Reference 2: Reference 3:
Before submitting this application, please attach a one-page letter of intent containing a statement of your career goals and reasons for pursuing a Community Pharmacy Residency and a curriculum vitae. You may upload a coverletter in Microsoft Word or Adobe PDF formats: You may upload a Curriculum Vitae in Microsoft Word or Adobe PDF formats: Your entire application must be received no later than January 1. (see below for address). For faster processing, we highly recommend mailing in all supplemental materials including your transcripts within one week of submitting your online application.
By clicking on the “submit” button, I hereby certify that the above information is complete and correct to the best of my knowledge. I grant the University of North Carolina at Chapel Hill School of Pharmacy and Community Pharmacy Residency site(s) permission to request additional information, if necessary, from previous schools and employers concerning my academic and professional liability. If selected for the Residency, I agree to abide by the rules and regulations of the Community Pharmacy Residency site and the University of North Carolina at Chapel Hill School of Pharmacy.
Please send any and all supplemental application materials by January 1, to: Stefanie P. Ferreri, Pharm.D., CDE, FAPhA Clinical Assistant Professor Director, Community Pharmacy Residency Program University of North Carolina at Chapel Hill Eshelman School of Pharmacy CB 7360 Beard Hall Chapel Hill, NC 27599-7360 Phone 919-843-9765