EAST TENNESSEE STATE UNIVERSITY



Gatton College of Pharmacy

East Tennessee State University

Application for Transfer

Instructions

1. Complete the attached application in its entirety.

2. References: You are required to submit two letters of references as described below.

a. A letter from the Dean of Student Affairs of the pharmacy school at which you are enrolled stating that you are eligible to continue in that program and whether you were subject to any disciplinary action.

b. A letter from a member of the pharmacy school faculty with pertinent personal and academic knowledge about you.

3. Transcripts: You are required to submit official transcripts from all colleges/universities and pharmacy schools attended. The transcripts must be sent directly from the registrar’s office.

Note: An unofficial transcript is acceptable as part of the initial application

4. Test Scores: You are required to submit an official report of your PCAT scores.

a. Note: A copy is acceptable with the initial application.

5. Syllabi: You are required to submit copies of the course syllabus from all coursework taken as part of the professional pharmacy curriculum in which you earned credit. The course syllabi are used to evaluate course equivalency and to determine your academic standing.

Note: All syllabi must be received in order for the committee to evaluate your application

6. The application and all materials should be submitted to:

Office of Student Affairs

Gatton College of Pharmacy

Box 70414

Johnson City, TN 37614

GATTON COLLEGE OF PHARMACY

EAST TENNESSEE STATE UNIVERSIT

Application for Transfer Admission

I. General Information

|Last Name |First Name |Middle Name |Other Names Used |

| | | | |

|Current Mailing Address |

| |

|City |State |County |Country |Telephone |

| | | | | |

|Permanent Mailing Address |

| |

|City |State |County |Country |Telephone |

| | | | | |

|Date of Birth |Gender* |Ethnicity* |Email |

| | | | |

*statistical purposes only

|Are you a U.S. Citizen: |Yes | | |No | |

| |If no, indicate your status: | |

| |Note: Only Permanent Residents or Asylees are eligible for admission |

II. Pharmacy Schools Attended

(List all pharmacy schools attended in chronological order starting with current/most recent)

|Name of School |Location |Dates of Attendance |Current Status |

| |(city, state) |(mo/yr – mo/yr) |(e.g., enrolled/ withdrawn) |

| | | | |

| | | | |

| | | | |

|Are you in good standing at the pharmacy school you currently |Yes | | |No | |

|attend/most recently attended? | | | | | |

| | | | | | |

| |If not, you must provide an explanation below: |

|(Text box will expand as you type.) |

| |

III. Other Post-secondary Institutions Attended

(List all post-secondary institutions, excluding pharmacy schools, attended in chronological order)

|Name of |Location |Dates of Attendance |Degree Received|Date of |

|School |(city, state) |(mo/yr – mo/yr) | |Degree |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

IV. Reason for Transfer

In the space below, describe your reason(s) for seeking transfer to the ETSU College of Pharmacy. Attach an additional sheet of paper if necessary.

|(Text box will expand as you type.) |

| |

VI. Certifications

Were you ever the recipient of any action (e.g. dismissal, disqualification, suspension, probation etc.) by any college or university for unacceptable academic performance or conduct violations?

If yes, explain in the space below.

| |

Are you currently under indictment for or have you ever been convicted of a felony?

If yes, explain in the space below.

| |

I hereby certify that all statements in this application are accurate and complete. Failure to submit accurate and complete information shall be considered utterance of a false oath on an official document and may result in the immediate termination of an application or dismissal of the student without refund of fees. It is a Class A misdemeanor to misrepresent academic credentials.

| | | |

|Signature | |Date |

East Tennessee State University is a Tennessee Board of Regents institution and is fully in accord with the belief that educational and employment opportunities should be available to all eligible persons without regard to age, gender, color, race, religion, national origin, disability, veteran status, or sexual orientation.

East Tennessee State University makes available to prospective students the ETSU Security Information Report. This annual report includes campus crime statistics for the three most recent calendar years and various campus policies concerning law enforcement, the reporting of criminal activity, and crime prevention programs. The ETSU Security Information Report is available upon request from the Department of Public Safety, Box 70646, Johnson City, TN 37614. The report can be accessed on the Internet at .

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