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Summary: OFFICIAL USE ONLY:
DATE RECEIVED: _________CHECK NO.________ FEE WAIVER:______ AMOUNT:____
SUPPLEMENTAL APPLICATION FEE PAYMENT
For students entering Fall 2012
Thank you for applying to the UCSD Skaggs School of Pharmacy. In addition to the online
PharmCAS application, the supplemental application fee payment must be postmarked by
November 1, 2011 for your application to be considered complete. To pay your supplemental
application fee, please:
Complete the lower section of this form;
Make a check or money order for $60.00 payable to UC REGENTS;
Enclose this form and your payment in an envelope;
Mail envelope to:
University of California, San Diego
Skaggs School of Pharmacy and Pharmaceutical Sciences
ATTN: Admissions
9500 Gilman Drive, MC 0657
La Jolla, California 92093
Print Name PharmCAS Number
Signature Date
Note: All transcripts and reference letters must be sent to PharmCAS. Please do not send these
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