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Rx Immigration USA Visa Assistance

Foreign Candidate 
Registration 
This registration form is for foreign pharmacy candidates only. Only submit this form if you are a foreign pharmacist or other pharmacy professional who wishes to receive assistance with immigration into the United States. If you represent a company interested in hiring foreign pharmacy professionals, please click here to contact a representative. Please fill out the following form completely and click the send button at the bottom of the page.

Personal Information
First Name

 Last Name
E-mail Address

 Phone number
Country of Residence
Education/Degree Received
Employment
Passport Held
Age


Exam Information (Please check all that apply)

- Foreign Pharmacy Graduate Equivalency Exam (FPGEE)
I have applied to take the FPGEE.
I have passed the FPGEE.
Date Passed (mm/dd/yy):

- Written English Exam (TOEFL)
I have applied to take the TOEFL.
I have passed the TOEFL.
Date Passed (mm/dd/yy):

- Spoken English Exam (TSE)
I have applied to take the TSE.
I have passed the TSE.
Date Passed (mm/dd/yy):


Additional Information Please answer all questions

Was your pharmacy education at least a 5 year curriculum?
Yes No
Do you have a license to practice pharmacy in the country where you earned your pharmacy degree?
Yes No
Have you ever been denied a pharmacy license in the country where you earned your pharmacy degree?
Yes No
Has your pharmacy license ever been revoked?
Yes No
Have you previously been denied application for a US visa?
Yes No
Do you have a criminal record in any country?
Yes No

Please use this area to share any additional
information that you feel may be important.


WE ARE RELYING ON THE ACCURACY AND TRUTHFULNESS OF THE INFORMATION YOU PROVIDE IN THE PRE-SCREENING INFORMATION AND MAY REMOVE YOU FROM THE RXIMMIGRATION PROGRAM IF ANY INFORMATION IS FOUND TO BE FALSE OR INACCURATE.

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