PGY-1 Application

Welcome to Valley Medical Center Pharmacy Resource Center

General Practice Residency (PGY-1) Application

PGY-1 Application

Last Name

First Name

Middle Name

Match Number

Please indicate which address you would prefer to receive correspondence during the application process.

Permanent Address

Temporary Address

Street, Apt. #

City, State, Zip Code

Day Phone

Evening Phone

Email Address

List of Colleges / Universities Attended: (list most recent first)

1) Name/Location:

Dates Attended:

Degree Received:

2) Name/Location:

Dates Attended:

Degree Received:

3) Name/Location:

Dates Attended:

Degree Received:

Letters of Recommendation
Letters of recommendation must be from three professionals who can attest to your practice abilities and aptitudes. Please list names and email addresses of references below. Inform the recommender to email to both Brenda_donehower@valleymed.org and Vivian_Nguyen@valleymed.org originating from the email address supplied below.

Names

Email Addresses

File Uploads

Letter of Intent:
Curriculum Vitae:

Application Requirements:
All application materials must be received no later than Friday January 7, 2011 as described below.

Completed online:
Application Form

Uploaded online:
Letter of Intent
Curriculum Vitae

Received by email:
3 letters of recommendation

Postmarked on:
Official Transcripts

By checking this box, I certify the information submitted in this application is complete and correct to the best of my knowledge and belief. I grant Valley Medical Center permission to request additional information, if necessary, from previous schools and employers concerning my academic records and professional ability.

Have official transcripts addressed to:

Brenda Donehower, Pharm.D., BCPS
Clinical Coordinator
Residency Program Director
Valley Medical Center
Department of Pharmacy
400 S 43rd St.
P.O. Box 50010
Renton, WA 98058-5010

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as to the use of this information outside of Valley Medical Center.