Applications - University of South Carolina：应用-南卡罗来纳州大学

SouthCarolinaCollegeofPharmacyBoardApplicationProcessUSCCampusNameInformationIMPORTANTOnALLdocuments,listyournameEXACTLYasitappearsonthegovernmentissuedIDyouplantopresentattesting.CollegeAffidavitandCertificationofClinicalExperience–CompletedOnlineTheUSCcampusDeanwillbecompletingtheCollegeAffidavit(topofpage6)andCertificationofClinicalExperience(page8)componentsoftheSCBoardofPharmacyApplicationforExamination.Thestudentisresponsibleforprintingandcompletingtherestoftheapplication.SouthCarolinaapplicationcanbefound:http://www.llr.state.sc.us/POL/Pharmacy/PFORMS/Pharmacist%20Licensure%20by%20Exam%20Complete.pdfApplicationforExaminationIfyouareapplyingforyourlicenseinanyotherstate,letDianeWise(wise@sccp.sc.edu)knowassoonaspossiblesoshecanfilloutthenecessaryformsforthosestates.Also,makesureyoulookupthedeadlinesforapplicationforyourstateaseverystate’sapplicationprocessifdifferent.Somestatesrequireyoutocompleteanonlineapplication.Makesureyouhavemetthehoursofpracticalexperiencerequirements,whichmayvaryaccordingtostate.SCCPApplicationProcessStudentswillbenotifiedbyemailafterthecollegeaffidavitportionandcertificationofClinicalExperienceformshavebeencompletedandareavailableforpickupinCLS109.Applicationcannotbecompleteduntilthestudenthascompletedtheirfinalrotation.Cannotreceiveschoolsealfromofficeofenrollmentservicesuntilallgradeshavebeenpostedandverified.CompletedApplicationsIfyouareoutofstateandwishforyourformstobemailedtoyou,emailDianeWisewiththerequestandcurrentmailingaddresswise@sccp.sc.edu.Pleasedonothavesomeoneelsepickupyourapplication!PracticalExperience(Page4)Listpracticalexperienceunderthesupervisionofalicensedpharmacistinchronologicalorder.TheseareyourInternshiphours,notyourrotations.CollegeClerkshiporRotations(Page4)Thereisonlyroomtoput4ofyournineortenrotationsonthissectionoftheform.Youmaylistthefirstfourandbelowwrite(seeattached).Onaseparatesheetofpaperlisttheremainingrotationsinchronologicalordermakingsuretoputyournameontheattachment–or(writeseeattached)andprintyourrotationsfrome*value.Itwillhaveyournameprintedandyourrotationslistedinchronologicalorder.PreviousExaminationRecordPreviousLicensureasPharmacist(Page4:PracticalExperienceSection)IftheapplicanthaspreviouslytakentheBoardexaminationforpharmacistlicensureinthisoranyotherstate,hemustdiscloseplaces,datesandresultsintheprovidedspaces.Ifnone,typeN/A.RECORDOFCHARGES,CONVICTIONSANDFINESIMPOSEDONAPPLICANT(Page5)Pleasereadtheinstructionsandcompletethestatementaslistedontheform.AffidavitSectionofFormPROOFOFQUALIFICATIONS(Page5:RECORDOFCHARGES,CONVICTIONSANDFINESIMPOSEDONAPPLICANT)Makesureyousignthisportionoftheform.HaveformnotarizedbyEmilyWillinghaminCLS-110A,orotherNotaryPublic.ProofofQualificationsBirthCertificatesHaveacertifiedcopyofyourBirthCertificate.PleasenotethatthebirthcertificateyousubmitwillNOTbereturned.BirthCertificatesmaybeobtainedbycontacting:Columbia,SCOfficeofVitalRecordsSCDHEC,2600BullStreet,Columbia,SC29201(803)898.3630;8:30am-4pmhttp://www.scdhec.gov/administration/vr/birth.htmProcessing:mailordermaytakeweeks,phoneoronlinewilltake5-7businessdays,walk-inswilltakeapprox.1hourProcessingfeeof$12-$17CharlestonCountyPublicHealthDepartment4050BridgeviewDrive,Suite475NorthCharleston,SC29405(843)746.3801http://vitalrec.com/sccounties.html#CharlestonProofofQualificationsBirthCertificatesOutofstatestudentswillneedtocheckintheirrespectivehomestatesforacertifiedbirthcertificate.Donotdelayasthisprocesscouldtakesometimetocompletedependingonyourplaceofbirth.Inmostcases,asimpleonlinesearchwilldirectyoutothecorrectgovernmentagencytorequestabirthcertificate.Bemindfulthattherewilllikelybeafeeforrequestingthebirthcertificate.CharacterVouchers(Page6)StudentswillhavethisportioncompletedaftertheyreceivethecompletedCollegeAffidavitportionfromtheCollegewiththeschoolseal.CharacterVouchersA&Bmustbecompletedandsignedbytwolicensedpharmacists.ThesignaturesforCharacterVouchersA&Bmustalsobethesignaturesonthe(A)(B)linesonthebackofthepictures(page7).Onepicturewillbesubmittedwiththecompletedapplication.Onepicturewillbepresentedbytheapplicantatthetimeofexamination.CertificationofClinicalExperience(Page8)MustbecompletedbytheCollegeandsignedbytheDeanIfyouareapplyingforlicensureinanotherstateyouwillhavetocompletethisformandsendto:SouthCarolinaBoardofPharmacyPostOfficeBox11927Columbia,SC29211-1927Oryoumayhanddeliverto:110CenterviewDrive,Suite201Columbia,SC29210AffidavitofEligibility(Page9and10)ALLapplicantsforaSouthCarolinalicenseafterJuly1,2008,arerequiredtocompleteandsigntheAffidavitofEligibility.Pleasechecktheacceptablesecureandverifiabledocument(s).Acopyoftheverifiabledocument(s)mustbeattachedtotheAffidavitofEligibility.ApplicationSubmissionSubmityourentireApplicationforExaminationtoavoidconfusionandmissingsegments.Paythe$100.00fee.EncloseaCertifiedcopyofyourbirthcertificate.Encloseonepicturewithsignedattachment.*Keep2ndpicturewith2signaturestopresentwhentakingtheexam!EncloseCertificationofClinicalExperiencesignedbyDean.EncloseattachmentstatingyouhavecompletedtheNAPLEX/MPJEregistrationwiththeNationalAssociationofBoardsofPharmacy(NABP)signyournameontheattachment(seeexampleonfollowingslide).MailApplicationto:SouthCarolinaBoardofPharmacyPostOfficeBox11927Columbia,SC29211-1927Handdeliverapplicationto:110CenterviewDrive,Suite201Columbia,SC29210OncetheApplicationissubmitted,studentsmaycheckthestatusoftheirApplicationontheLLRwebsite.Yourapplicationisvalidforoneyear.ExampleStatementI,_________________________________________,havecompletedtheregistrationfortheNAPLEX/MPJEwiththeNationalAssociationofBoardsofPharmacy(NABP). _____________________________________SignatureDate ApplicationSubmissionStudentsmaycompletetheNAPLEXandMPJEregistrationprocesseswiththeNationalAssociationofBoardsofPharmacy(NABP)priortosubmittingtheirSCBoardofPharmacyApplicationforExamination;thisisaseparateprocess.SCCPdegreecandidatesshouldselect:SC104SouthCarolinaCollegeofPharmacyfromtheSchoolCodeListwhensubmittingtheirNAPLEXandMPJEregistrations.ApplicationSubmissionApplicationsforGA,ALABAMA,NORTHCAROLINAANDTEXASaswellasSOMEOTHERSTATESWILLNOTBEACCEPTEDUNTILTHEDATEOFGRADUATIONORAFTERGRADUATION.EnrollmentServiceswillnotapplytheschoolsealfortheseStatesuntilthedayofGraduationorafter.YoumaypickupthecollegeaffidavitportionoftheseapplicationswhenyoureceiveyourDiploma(followinggraduation),fromDianeWiseinCLS-109.Makesureyoulookupthedeadlinesforapplicationforyourstateaseverystate’sapplicationprocessisdifferent.InitialLicensureProcessAfterpassingtheNAPLEXandMPJE,youwillreceiveaPharmacist’sInitialLicensureApplicationandaninformationsheet.Bothformsmustbecompletedandsubmittedalongwitha$70initiallicensurefee.Thisprocessmustbecompletednomorethan30daysafterreceipt.CostAssociatedwithSCLicensureProcessMPJE=$210perstate(creditcardonly)NAPLEX=$505examfee(creditcardonly)Submissionfee=$100(checkormoneyorder)InitialLicensure=$70(checkormoneyorder)Application___________________________________TotalforSC=$885Licensureprocess