UCSF School of Pharmacy

Form A: General UCSF Application

This form is required.

Form A: General UCSF Application PDF, 1 page, 216 KB Requires Adobe Reader.

Instructions for Completing Form A

1. You must complete this form on a computer using Adobe Reader or Adobe Acrobat. If you're not familiar with these software products, see About Adobe Reader.

2. Download and Save Before Starting

   We recommend that you download and save the forms to your computer and complete them in Adobe Acrobat or Adobe Reader. If you instead view and complete the forms in your web browser, you might lose data you entered if you select a hyperlink which takes you to a different web page. Saving the forms to your computer and completing them in Adobe Acrobat or Adobe Reader prevents this problem.

   Saving the Information You Enter

   If you use the free Adobe Reader, be aware that Adobe Reader does not permit you to save the information you enter like Adobe Acrobat does. For details, see About Adobe Reader. If you don't have Adobe Acrobat and you don't want to purchase it, we recommend that you:

   1. Check what other resources available to you might have Adobe Acrobat: your public library, the computer lab at your school, nearby Internet cafés, your friends or family who are knowledgeable about computers. For example, work at Kinko's, saving your forms to your own USB drive.
   2. Or, complete each form only when you can do so in a single sitting where you have the ability to print. (You do not need to complete all the forms in a single sitting.)

   Adobe Acrobat is not required to complete our forms, and UCSF will not reimburse you for purchasing it.

3. Within Adobe Reader or Adobe Acrobat, you can make the form easier to read by using the zooming tools.
4. Use a pen to sign and date the form. Your signature must match the legal name you specified in section A1.

Notice of Equal Opportunity

The University of California in compliance with Title VI and VII of the Civil Rights Act of 1964 as amended, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, does not discriminate on the basis of race, color, religion, national origin, sex, mental and physical disabilities, or age in any of its policies, procedures, or practices; nor does the University discriminate on the basis of sexual orientation. This nondiscrimination policy covers admission and access to, and treatment and employment in, University programs and activities, including but not limited to, academic admissions, financial aid, educational services, and student employment.

Inquiries regarding the University's equal opportunity policies may be directed to the Director of Affirmative Action/Equal Opportunity, University of California, San Francisco. Telephone: 415/476-4752.

Federal Privacy Act of 1974

The Social Security number will be used by the University to verify your identity. Disclosure of your Social Security number is mandatory. This notification is provided to you as required by the Federal Privacy Act of 1974. The University's record-keeping systems relating to this application were established prior to January 1, 1975, pursuant to the authority granted to The Regents of the University of California under Article IX, Section 9, of the California Constitution. If you are a United States citizen and do not have a Social Security number, apply for one through the nearest district Social Security Office and notify the Office of Admission and Registrar when you receive it. If you are not a United States citizen and live in another country, it is not necessary for you to secure a Social Security number.

Students With Disabilities

Services for students with disabilities at UCSF are coordinated by the Office of Student Life. Among the services available to meet the individual needs of students with disabilities are: interpreter, reader, and note taker services which are necessary to allow a student to complete the academic program; special parking; registration assistance; test-taking arrangements; special orientation to the campus physical environment; liaison with the California State Department of Rehabilitation; and referral to resources, services, and agencies. For more information, please contact the Office of Student Life, 126 Millberry Union, UCSF, San Francisco, CA 94143-0376; 415/476-4318 (voice and TDD).

Information Practices Act of 1977

The State of California Information Practices Act of 1977 requires the University to provide the following information to applicants for admission who are asked to supply information about themselves. The principal purpose for requesting information on this form is to process your application for admission. Maintenance of this information is authorized by University policy. Furnishing certain information requested on this form is specifically noted as optional or voluntary. There is no penalty if you do not complete these items. Furnishing information that is not designated voluntary or optional is mandatory. Failure to provide such information will delay or may even prevent completion of the admissions process. Information furnished on this form may be used by various University departments for admissions and other student-related purposes, such as housing and financial aid. This information will be transmitted to the State and Federal governments if required by law. The official responsible for maintaining the information contained on this form is the campus Admissions Officer. Telephone: 415/476-8280.

A4. Statistical Information

Please indicate your ethnic identity and sex by checking the appropriate boxes. This information has no bearing on your eligibility for admission, and providing it is voluntary. By doing so, you provide information that will help the University to plan student programs and measure their effectiveness.

• (A) American Indian/Alaska Native: The term "American Indian/Alaska Native" refers to an Indian tribe, band, or other organized group of Indians, including those groups currently or formerly recognized by the federal government, and/or those recognized by the state in which they reside. For more information contact the UCSF Office of Affirmative Action/Equal Opportunity/Diversity, 415/476-4752.
• (J) Latino/Other Spanish-American: Including Cuban, Puerto Rican, Central American
• (M) Pacific Islander: Includes Micronesian, Polynesian, Other Pacific Islanders
• (N) Other Asian: Not including Middle Eastern
• (P) White/Caucasian: Including Middle Eastern

Problems? Questions?

See Supplemental Application Help.

Next Form: Form B: Biographical Information

Go To: Supplemental Application Forms or Supplemental Application