SOP Seat Deposit

Decision on Offer of Admission PharmD
Please check one of the following boxes to indicate your decision to accept or decline the South College School of Pharmacy Offer of Admission in the Pharm.D. Class of 2021 no later than 14 days from the receipt of offer.
If not accepting offer of Admission, please describe the reason for your decision:
By accepting the Offer of Admission I understand and agree that if I do not complete all admissions requirements prior to June 1, 2018, this Offer of Admission may be withdrawn. I have read, understand, and agree to the School of Pharmacy Matriculation Policies and Requirements.
I am submitting payment in the amount of seven hundred fifty dollars ($750.00). This deposit is to hold a place in the Pharm.D. Class of 2021 for me and will be applied directly to my tuition and fees when I matriculate. Deposit is non refundable. I have read, understand, and agree to the ACPE Disclosure Statement. I understand and agree that this deposit will be forfeited if I (1) fail to register, (2) later renege on my acceptance of the Offer of Admission, or (3) fail to provide a clean background check and drug screen prior to matriculation. (4)Do not complete all admission requirements.
Last Name (required):*
First Name (required):*
Middle Name:
Maiden Name:
Date of Birth:*
Social Security Number:*
PharmCAS Application Number:*
Please list the telephone number at which you can be reached between 8:00am and 5:00pm EST (required):*
Home Telephone:
Cell Telephone:
E-mail (required):*
Address (required):*
*By entering your full 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 as well as authorize the payment of the admission fee to South College.
*As acceptance of this registration, please type your full name below.
Applicant Signature:*
*Please enter the last four digits of your social security number.
Last Four of Social:*
Word Verification: