Pharmacy Technician Training Course Application

*Required Fields

Please note:  International students are not eligible for the Pharmacy Technician Training course at this time.  
PERSONAL INFORMATION










CONTACT INFORMATION










PERMANENT ADDRESS
(If different from mailing address)








EMERGENCY CONTACT



EDUCATIONAL INFORMATION








PERSONAL HISTORY
1.  Have you ever been found responsible for a disciplinary violation at an educational institution you attended from 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in you being dropped, warned, advised or required to withdraw, or your probation, suspension, removal, dismissal or expulsion from the institution?*
2.  If you served in the military, did you receive any type of discharge other than honorable?*
3.  Have you ever been arrested for, charged with or convicted of a misdemeanor or felony crime? You must include juvenile offenses, alcohol offenses, including driving under the influence of alcohol and drugs and adjudications withheld by court. Also include any misdemeanor or felony offenses for which the charges were dropped, dismissed, referred to a pretrial intervention program and/or prosecution was deferred. If you have been arrested for charge with or convicted of a felony, including adjudication withheld, you must provide copies of official documentation that demonstrates disposition of each matter. Have you otherwise accepted responsibility for commission of a crime or do you have any criminal or disciplinary charges pending against you? The university has the right to require applicants to submit the results of a criminal background check to verify the information you disclose herein. Additionally, the university may revoke an acceptance if the applicant has not made a full disclosure.*
4.  I understand that I have a continuing responsibility to notify the university of any and all changes in the information I have submitted that occur at any time after filing this application, including during my enrollment in the university.
CERTIFICATION OF INFORMATION

I certify that the information provided on the application for admission to St. Thomas University and all supplemental forms are complete and accurate. I understand that omission or misrepresentation of facts therein may be cause for denial of admission, revocation of admission, dismissal after enrollment, revocation of the degree for which I am enrolled, or any other action necessary as deemed by the university. I further understand that I have a continuing responsibility to notify St. Thomas University of any and all changes in the information I have submitted that occur at any time after filing this application, including during enrollment in St. Thomas University.


I understand that subject to St. Thomas University’s policies and procedures, I may be required to submit to a urine or blood test or other procedure to detect, among other things, for controlled substances. I acknowledge that the report of any such test may be released to St. Thomas University and to its agents and contractors with a legitimate need to know of those reports.


4/18/2014 9:07:39 AM

Signature of parent or guardian, if applicant is under 21. I approve the foregoing application, I understand and accept the regulations governing the acceptance of this application.



St. Thomas University admits students of any gender, race, color, national and ethnic origin to all rights, privileges, and activities generally accorded or made available to students at the university. It does not discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.