Registration for the Community Pharmacy Ownership Elective

INSTRUCTIONS:

Please complete the registration request form below. Please also note that once you begin filling out the registration request form you must complete it in its entirety as there is no ability to save your work. Please use the submit button at the bottom of the form.
Provide a Transient Permission Form or Letter of Good Standing from your college dean or registrar’s office. This document must be submitted by email (preferred), fax 678.547.6518, or postal mail to the following address:

Mercer University College of Pharmacy
Pharmacy Admissions – PAC-121
3001 Mercer University Drive
Atlanta, GA 30341

Once your Registration Request and Transient Permission Form/Letter of Good Standing are received, you will be notified by email. The email will provide you with your Mercer ID number and instructions on how to complete registration for the course. If you have any questions about the registration process, please contact the admissions office at 678.547.6232.

Citizenship Status

State of Legal Residence

Gender

Female

Male

Ethnicity

Race

Name of Pharmacy School Currently Attending*

Have you previously attended Mercer?

Yes

If yes, what year?

I certify that the information presented in this registration request form is factually correct and honestly provided. Please acknowledge the previous statement by typing your name in this box*

Mercer University is committed to providing equal educational programs or activities, and equal employment opportunities to all qualified students, employees, and applicants without discrimination on the basis of race, color, national or ethnic origin, disability, veteran status, sex, sexual orientation, age or religion, as a matter of University policy and as required by applicable state and federal laws, including Title IX. Inquiries concerning this policy may be directed to the Equal Opportunity/ Affirmative Action Officer/Title IX Coordinator, Human Resources Office, 1400 Coleman Avenue, Macon, Georgia 31207, phone 478.301.2786, or in cases of Title IX concerns, these concerns may be referred to the Office of Civil Rights.