SOP Supplemental Application

South College
School of Pharmacy
400 Goody's Lane
Knoxville, TN 37922

pharmd@southcollegetn.edu

Name:*
Under what other name(s) might documents be received?
Date of Birth:*
Place of birth:*
Age:*
Social Security Number:*
Race:*
Sex:*

*INFORMATION NEEDED FOR STATISTICAL REPORTING TO THE U.S. DEPT. OF EDUCATION.

Home Phone:
-
Cell Phone:
-
E-mail:*
PharmCAS application ID#:*
Permanent Address:*
Temporary Address:
Preferred mailing address:
County and state of legal residence:
Spouse/Guardian's Name:
Spouse/Guardian's Address:
Spouse/Guardian's Home Phone:
-
Spouse/Guardian's Cell Phone:
-
Emergency Contact Name:
Relationship:
Emergency Contact Address:
Emergency Contact Phone:
-
Are you a United States Citizen?*
If No, indicate Legal Status:
How did you learn about the School of Pharmacy and its Pharm.D. Program?
Have you taken the PCAT exam?
If Yes, when?
Results - Composite Score:
DO YOU WISH TO APPLY FOR FINANCIAL AID?
FERPA RELEASE

South College provides for the confidentiality of student records in accordance with the Family Educational Rights and Privacy Act (FERPA), as amended. I understand that in order to consider my application to the School of Pharmacy, the Office of Admissions will release my student records as necessary to members of the School of Pharmacy Admissions Committee, employees of South College and others who have a need to access my student records in order to process my application for admission.

RELEASE

I hereby release South College and any firm with which South College may contract, from any debts, claims, actions, causes of action, demands, suits, and all liabilities whatsoever both in law and in equity, which may result from participation in any telecast or still photography made by or produced by South College.

In doing so, I hereby grant South College the right to use my name, photograph, likeness, or voice in any production connected with the College.

 I hereby represent and warrant that I am of full age and have every right to contract in my own name in the above regard. I further state that I have read the above authorization and release prior to its execution and that I am fully familiar with the contents thereof.

I certify that all statements made in this supplemental application are complete and true and understand that every student enrolling at South College agrees to abide by all policies and regulations of the College that may be found in the Student Handbook or in the College Catalog or other official publication. I understand and agree that any misrepresentation of facts on this supplemental application is just cause for refusal of admission or dismissal from South College.

As acceptance of this registration, please type your full name below.

Applicant signature:*

By entering your name, the last four digits of your social security number, and submitting the document, you electronically agree and confirm your understanding of the items, as outlined, in the above document.

Last four of social:*

Please enter the last four digits of your social security number.

Word Verification: