Program Type *:
-- Select Type --
Session start date:
-- Select Session --
OCP Registration Number:
Date of Birth *:
Preferred Title *:
-- Select Title --
Legal Last Name *:
Former Last Name:
Legal First Name *:
Phone Number *:
Email Address *:
Street Address *:
Postal Code *:
Until what date are these addresses valid *:
Status In Canada *:
-- Select Status --
Student and/or Employment Visa
No Complete Visa
If visa, expiry date:
Did you graduate from a High School in Canada?*
Please indicate the province/territory:
-- Select Title --
Newfoundland and Labrador
Prince Edward Island
Did you graduate with a Canadian University degree*
Please indicate the degree obtained:
Academic Institution Attended for Pharmacy Degree*:
Year of Graduation *:
Do you have a current (in the last 2 years) fluency test? *
Which test have you completed?
Do you have a letter from OCP to exempt you from the fluency requirement? *
Have You Completed the PEBC Evaluation Exam?
Which month and year did you complete the exam in?
Which month and year do you intent to complete the exam?
How Many Times Have You Attempted The PEBC Qualifying Exam Part I?
Have you successfully passed the PEBC Qualifying Exam Part I?
How Many Times Have You Attempted The PEBC Qualifying Exam Part II?
Have you successfully passed the PEBC Qualifying Exam Part II?
Have you paid your $250 (+ HST) application fee?
What is the confirmation number for the application fee payment?
Please remember to pay the fee here
How did you hear about the IPG program:
-- Select Option --
Please email all supporting documents (PEBC EE result letter, valid English fluency test, recent resume, copy of Canadian status document) directly to the IPG office, email@example.com
By submitting and completing my CPS application, I consent to the following:
Do you consent to all of the items listed above *