APPLICATION FOR ADMISSION TO THE PH.D. PROGRAM
IN PHARMACEUTICAL SCIENCES
 
MERCER UNIVERSITY COLLEGE OF PHARMACY
3001 MERCER UNIVERSITY DRIVE
ATLANTA, GA 30341-4155
678-547-6730 - 678-547-6423 (FAX)
 
Please complete all entries in each section of this application. Date:
 
Social Security Number:  Gender: Email:
Full Legal Name Last,Family: First: Middle:
Maiden or other name(s) on transcripts:
Permanent Address:
City: State: Zip Code:
Permanent Phone:
Present address same as permanent address     
Present Address:
City: State: Zip Code:
Present Phone:
Communications should be sent to:
Date of Birth:        Place of Birth:     
Marital Status:  
Are you a veteran?
Citizenship status: U.S. Visa Type: (If applicable)
Are you Hispanic or Latino?  
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member: