Supplemental Application Submission Form

Supplemental Application for Admission
Doctor of Pharmacy Degree Program
Auburn University
Harrison School of Pharmacy
Office of Academic and Student Affairs
2317 Walker Building
Auburn University, Alabama 36849-5501
(334) 844-8348 - Fax (334) 844-8353

Note: After submitting the application, a non-refundable fee of $50 should be mailed to the address above.

I certify that the information contained on this application is correct and complete to the best of my knowledge and that I am solely responsible for its contents. I realize that deliberate misrepresentation in any statement on this application or in an interview will be considered adequate grounds for denying me admission to or expelling me from the Harrison School of Pharmacy. I also certify that I have carefully read and understand all of the criteria and requirements for admission to and continued enrollment in the Harrison School of Pharmacy and I agree to abide by them. I realize that my application will be rejected without further review for any of the following: failure to provide all requested information and materials; failure to adhere to all required procedures; or failure to meet specified deadlines. I understand that if I am invited to appear for an interview on a specified date, alternate arrangements may not be possible.

I have read and accept the above statement:

Date:

Revised July 2008

Name: Last, First Middle		Name Preference:
Address: Permanent Street Address (Legal Home) Apt. Number		Phone: (xxxxxxxxxx format)
City:	County:	State:	Zip:
Address: Local or Present Street Address Apt. Number		Phone: (xxxxxxxxxx format)
City:	County:	State:	Zip:
AU Banner ID (if known):	Birth Date (MM/DD/YYYY):	Age:	Sex:
Email Address: If you do not have a valid email address, application must be submitted by US mail to address at top of form. Please allow 4-6 weeks additional for processing.		Parent Name: Parent Email Address: Please include for our records.
Are you a permanent resident of the U.S.?
Are any of your relatives currently enrolled or graduates of Auburn University?
If yes, check one or more of the boxes to indicate relationship: Parent Grandparent Child Sibling (Brother or Sister) Spouse
Are any of your relatives currently enrolled or graduates of Auburn University Harrison School of Pharmacy?
If yes, check one or more of the boxes to indicate relationship: Parent Grandparent Child Sibling (Brother or Sister) Spouse
Person(s) to contact in case of emergency: Last, First MI		Phone: (xxxxxxxxxx format) Daytime Phone Number
Relationship:		Phone (xxxxxxxxxx format) Evening Phone Number
Please indicate your campus preference from the following options:
Please list any college or university currently attending or previously attended, beginning with the most recent first:		Number of hours completed:
Next most recent college or university attended:		Number of hours completed:
Next most recent college or university attended:		Number of hours completed:
Highest degree previously earned:		Date of completion (mm/dd/yyyy): (list anticipated if not completed)
Have you ever attended any School or College of Pharmacy? If no, skip next three questions.
If yes, specify school and date(s) of attendance:
Are you eligible to return?
If not eligible to return, why not?
Have you applied to the Harrison School of Pharmacy before?		If yes, please select from the following options:
If yes, please describe what you have done to enhance your application this year:
Please state briefly who or what event(s) influenced your decision to enter the pharmacy profession:
Please describe activities in which you have been involved in providing care to others. Please describe in detail your responsibilities and the benefits to you and the recipient of your caring: