2026 Camp BoomeRx Application Survey

1.Contact Information(Required.)

Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.Are you a U.S citizen or permanent resident?(Required.)

Yes

No

Academic Background

3.Please list all colleges/universities attended and include dates of attendance for each one.(Required.)

4.What will be your academic standing after the conclusion of the Spring 2026 semester? (If you will be completing your freshman year, you will be a sophomore after the spring semester, etc.)(Required.)

Pharmacy Background

5.Please rate your interest level in pharmacy as a future career.(Required.)

I just found out about pharmacy, and I am ready to explore.

I am invested in pharmacy, and I want to learn more about the profession.

I'm sold. I'm a future pharmacist.

Voluntary Demographic Background Information

This is an optional section. These questions are designed to help us learn more about you and how we can best support your future goals. You may answer all, some, or none of the questions. Choosing not to answer will not impact the evaluation of your application.

6.What are you most passionate about in life?

7.What are some of your favorite things/activities to do in life?

8.What do you hope to gain from attending this camp?

9.Where did you hear about Camp BoomeRx? (email, college advisor, etc.)