Daniel K. Inouye College of Pharmacy Application Fee Form

The application fee is $50.00. You must pay this online with a Visa or MasterCard.

First Name:

Middle Name:

Last Name:

Email Address:

Re-enter Email Address:

Street Address:

City:

State/Country:

Postal Code:

Phone (primary):
888-888-8888

Phone (secondary):

UH Number:

PharmCAS ID:

Date of Birth:
MM/DD/YYYY