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Open House Travel Award Survey
Last, First Name
Email Address
Phone Number
Name of University/College
Name of Department or Major
Are you an American Association of Pharmaceutical Scientists(AAPS) Member? If so, please write your member ID
Yes
No
What is Your Current Academic Standing? If Other, Please Specify?
Freshman
Sophomore
Junior
Senior
Other
Expected Month and Year of Graduation
Are You Planning on Applying to a PhD Program?
I am Planning on Applying
I have Applied Before
I am not planning on applying
What is your mode of transportation
Car
Public Transportation
Uber/Taxi
Other
What is your estimated cost of travel? Please detail how you came up with your cost
Are you planning on travelling with others? If so, how many?
Yes
No
If yes to previous question, please provide names.
Did you attend the Eshelman School of Pharmacy Pharmaceutical Sciences Open House last year?
Yes
No
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