Loyola University Chicago Pharmacovigilance Certificate ApplicationComplete the below application to be considered for enrollment at Loyola University Chicago. Loyola University Chicago is an equal opportunity educator/employer. Read the University’s full non-discrimination policy here.Loading...Biographical InformationName PrefixBr.Dr.Fr.Mr.Mrs.Ms.RabbiRev.Sr.First Name (Given)Middle NameLast NameSuffixIIIIVJrMDMSWSJSrEmail AddressHome AddressHome AddressCountryStreetCityRegionPostal CodeBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900GenderFemaleMalePrimary CitizenshipAfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas Da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius, and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos Islands (Keeling Islands)ColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCoral Sea IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFederated States of MicronesiaFijiFinlandForeign/UnknownFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R.HungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan De Nova IslandKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.Macedonia, Republic of NorthMadagascarMalawiMalaysiaMaldivesMaliMaltaMan, Isle ofMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalau, the Pacific Islands ofPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSpratly IslandsSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweDual CitizenshipAfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas Da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius, and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos Islands (Keeling Islands)ColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCoral Sea IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFederated States of MicronesiaFijiFinlandForeign/UnknownFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R.HungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan De Nova IslandKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.Macedonia, Republic of NorthMadagascarMalawiMalaysiaMaldivesMaliMaltaMan, Isle ofMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalau, the Pacific Islands ofPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSpratly IslandsSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweResidency StatusResidency StatusU.S. Permanent ResidentPlease select the Visa you will be on to attend Loyola. If you are an undocumented student, a student eligible for deferred action or are uncertain, please select 'Other'.F-1 Student: Have VisaF-1 Student: Need VisaJ-1 Exchange Visitor: Have VisaJ-1 Exchange Visitor: Need VisaOtherWhat is your highest level of education completed?What is your highest level of education completed?High School/GEDSome College4-year DegreeMaster's DegreeDoctoral DegreeApplication InformationProgramProgramPharmacovigilance CertificateDesired TermDesired Term2020 Fall Semester2020 Spring Semester2021 Fall Semester2021 Spring Semester2022 Fall Semester2022 Spring Semester2023 Fall Semester2024 Spring Semester2023 Spring Semester2024 Fall Semester2025 Spring Semester2025 Fall SemesterHow did you hear about this program?Academic InformationPlease enter all colleges and universities attended. You may exclude High School or secondary education institutions. If you are a current Loyola student or previously attended Loyola, please include Loyola among the institutions below. If you have more than two instituations, please send via email to gradapp@luc.edu.Look up most recent collegeCollege CodeInternational students may enter "INTL" as a codeLevel of studyAssociate’s DegreeBachelor's DegreeCertificateDoctorateGEDGraduate/Professional DiplomaHigh SchoolMaster's DegreePost-Master’s DegreeSome CollegeUnknownLook up collegeCollege CodeInternational students may enter "INTL" as a codeLevel of studyAssociate’s DegreeBachelor's DegreeCertificateDoctorateGEDGraduate/Professional DiplomaHigh SchoolMaster's DegreePost-Master’s DegreeSome CollegeUnknownRound 2023 (hidden)2023 BIORound 2022 (hidden)2022 BIORound 2021 (hidden)2021 BIOApp submitted (hidden)YesNoEnrollment status (hidden)Full-TimePart-TimeExcluding minor traffic violations, have you ever been convicted of a felony or do you have any pending felony charges?Excluding minor traffic violations, have you ever been convicted of a felony or do you have any pending felony charges?YesNoIf yes, please use the box below to provide an explanation.Have you ever been disciplined or disbarred by a state and/or international bar, a licensing agency, or an accreditation/certification board?Have you ever been disciplined or disbarred by a state and/or international bar, a licensing agency, or an accreditation/certification board?YesNoIf yes, please use the box below to provide an explanation.Have you ever been disciplined, suspended, or expelled for academic or other reasons by an institution of higher learning or professional organization?Have you ever been disciplined, suspended, or expelled for academic or other reasons by an institution of higher learning or professional organization?YesNoIf yes, please use the box below to provide an explanation.Have you ever been discharged from military service under conditions other than honorable?Have you ever been discharged from military service under conditions other than honorable?YesNoIf yes, please use the box below to provide an explanation.RecommendationsThis program requires 2 letters of recommendation. Recommendations should be provided from professors, employers, supervisors, or others who are able to comment on your professional and educational goals and potential (no friends or relatives). Recommenders should send via e-mail to gradapp@luc.edu referencing your full name. CertificationI understand that official policies and procedures which govern enrollment at Loyola University Chicago are published or referred to in the University’s Schedule of Classes; the University’s Student Handbook; the catalog of each undergraduate, graduate, and professional school; and on the Loyola University Web site. I understand and agree that these policies and procedures, as revised from time to time, form the contract for my enrollment at Loyola University Chicago. I agree that I am responsible for obtaining and reviewing these policies and materials. I agree to be bound by them, and I will pay the tuition, fees, or other charges which are assessed in accordance with Loyola’s published financial policies. Former Loyola University Chicago students: by signing this application, you give your consent to the office of Graduate and Professional Enrollment Management to obtain your Loyola transcripts.I certify all information on this application form is complete and accurate, and that any uploaded statement, resume, and/or writing sample are my own work. I understand that any incorrect or incomplete information will invalidate this application and may jeopardize my enrollment and/or result in my dismissal. Loyola University Chicago reserves the right to request proof or validation of any information provided by applicants for admission.I understand I will be able to submit supporting materials, such as the statement of purpose, after submitting the application form.In place of your signature, please type your full legal name:Current_DateCurrent_DateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044Submit
