DOCTOR OF PHARMACY (PharmD) RHODES UNIVERSITY APPLICATION FOR ADMISSION TO POSTGRADUATE STUDIES

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1 DOCTOR OF PHARMACY (PharmD) RHODES UNIVERSITY APPLICATION FOR ADMISSION TO POSTGRADUATE STUDIES

2 CLOSING DATES 15 August APPLICATION FEE R75,00 RHODES UNIVERSITY POSTGRADUATE APPLICATION INSTRUCTION SHEET This application form is divided into sections. Please complete the sections that are relevant to your choice of study and return it to the University. Academic Transcript All postgraduate applicants are required to submit with the application form a full official academic transcript reflecting the detailed results, including percentage marks, of all previous qualifications and the award of degree(s). Copies of degree certificates do not constitute an academic transcript. Married women: Where your previous qualifications are in your maiden name, please supply a copy of your marriage certificate for record purposes. SECTION A To be completed by all students who are entering the University. The information from this section is required for statistical and record purposes and for the awarding of bursaries and scholarships. SECTION B Application for admission for a Doctoral degree. Forms should be submitted for consideration by 15 August. GUIDELINES FOR DOCTOR OF PHARMACY DEGREE Applicants are required to include a portfolio, evidence of registration with the SA Pharmacy Council and the names and addresses of three referees. Please send this to the Faculty of Pharmacy, Rhodes University, P O Box 94, Grahamstown, Please return the application form to:- The Registrar, Rhodes University, P O Box 94, Grahamstown, DIRECT DEPOSIT INTO RHODES UNIVERSITY'S BANK ACCOUNT Bank: First National Bank Branch: High Street, Grahamstown Account Name: FNB Student fees account Account Number: Branch Number: Swift code: FIRNZAJJ Details required on deposit slip: Student's Initial and Surname Student number (if applicable) Please fax a copy of the deposit slip to (046) or fees can be paid using Internet Banking. Please follow the bank instructions. (NB: Please ensure the student number is provided (if applicable))

3 FOR OFFICE USE ONLY SURNAME RHODES UNIVERSITY APPLICATION FOR POSTGRADUATE ADMISSION MAIDEN NAME (if applicable) MARITAL STATUS (single or married) FIRST NAMES IN FULL TITLE (Dr, Mr, Ms, Miss, etc) GENDER POPULATION GROUP (e.g. Asian, Black, Coloured, White) SECTION A INITIALS HOME LANGUAGE (e.g. Xhosa, English, Sotho, Afrikaans, etc.) CITIZENSHIP STATUS NATIONALITY 1. S.A. Citizen (if not South African) 2. Foreign, with SA permanent residence 3. Foreign, with temporary residence requiring study permit SA IDENTITY NUMBER, OR PASSPORT NUMBER Have you previously been enrolled at Rhodes University? (YES or NO) If YES, please give your student number DATE OF BIRTH DAY MONTH YEAR PLEASE INDICATE ANY PHYSICAL DISABILITY PROPOSED REGISTRATION Registration Status (Full-time/Part-time) In attendance OR not in attendance CHOICES OF DEGREE/DIPLOMA First Choice: Degree/Diploma in the Department of : Subject Second Choice: Degree/Diploma in the Department of: Subject YEAR OF ADMISSION: ADDRESS DETAILS NEXT OF KIN: Father Mother Guardian Spouse Other None TITLE, INITIALS, SURNAME OF NEXT OF KIN OCCUPATION RESIDENTIAL ADDDRESS OF NEXT OF KIN TELEPHONE: (Code) (Number) POSTAL CODE HOME POSTAL ADDRESS POSTAL CODE TELEPHONE: HOME: (Code) (Number) BUSINESS: (Code) (Number) FAX: (Code) (Number) address:

4 TITLE, INITIALS, SURNAME OF PERSON RESPONSIBLE FOR FEES, IF SELF, LEAVE BLANK If the person responsible for fees a full-time member of the Rhodes staff? (YES or NO) If YES, enter the Rhodes employee number ACCOUNT ADDRESS: If the same as the postal address, leave blank Postal code TELEPHONE: (Code) (Number) FAX (Code) (Number) IDENTITY NUMBER OF PERSON PAYING FEES WILL YOU BE STAYING AT HOME WHILE AT RHODES? (YES or NO) DO YOU WISH TO BE ACCOMMODATED IN ONE OF OUR UNIVERSITY RESIDENCES IN GRAHAMSTOWN? (YES or NO) HOUSE FOR WHICH YOU ARE APPLYING: FIRST CHOICE SECOND CHOICE MATRICULATION OR SCHOOL LEAVING DETAILS MATRICULATION YEAR: SCHOOL WHERE MATRICULATED PLEASE GIVE DETAILS OF THE LAST TERTIARY INSTITUTION THAT YOU ATTENDED UNIVERSITY/ DEGREE/ STUDENT NUMBER INSTITUTION QUALIFICATION DEGREE/QUALIFICATION COMPLETED? (YES or NO) DETAILS OF PREVIOUS YEAR S ACTIVITY (e.g. studying, working, travelling, etc) : All postgraduate applicants are required to submit with the application form a full official academic transcript reflecting the detailed results, including percentage marks, of all previous qualifications and the award of degree(s). Copies of degree certificates do not constitute an academic transcript. Applicants, who as the time of application are completing a degree requisite for admission, should submit all available academic results on application, with submission of the full/final academic transcript as soon as this is available. Married women: where your previous qualifications are in your maiden name, please supply a copy of your marriage certificate for record purposes.

5 DECLARATION AND AGREEMENT I/we, the undersigned, hereby declare that to the best of our knowledge and belief the information furnished in this application is true and correct and that if it be found to be false and misleading in any respect, this application may be invalidated and the applicant s registration terminated; and further agree: that I/we are liable personally or jointly and severally, as the case may be, for the full amount of fees, disbursements and other monies due or which will in the future become due to RHODES UNIVERSITY ( the University ) in respect of the whole period in which the applicant is registered as a student of the University, such monies being payable on or before the date(s) prescribed by the University: that I/we accept liability for any damage to University property howsoever caused by the applicant and indemnify the University against loss or damage howsoever caused in respect of property left at the University while the applicant is registered as a student: that a statement signed by the Registrar (Finance) shall represent the amount owing to the University by me/us, and further that in the event of such amount being handed over for collection I/we shall pay all legal charges incurred on the attorney and client scale: that I/we shall abide by all regulations of the University and further that the applicant shall, if accepted, be under the disciplinary control of the University as from the date on which he/she takes up residence at the University or the day on which he/she commences studies or attends an orientation week or summer school or similar function or registers as a student, whichever is the earliest, until the University accepts a notice of withdrawal from me/us or the applicant fails to renew his/her registration on the due date, whichever is the later: that the University may in its discretion report to the parent or major fee contributor such breaches of the rules and regulations by the applicant as the University deems necessary and further to report on any matter concerning progress, conduct, well-being or health of the applicant, and further that the University may take all such steps as it considers reasonable in the event of the applicant becoming ill or requiring medical attention. Dated: Signature of applicant:... Signature of guardian:... (if under the age of 21 years) Signature of person responsible for fees: Identity number of person responsible for fees..

6 RHODES UNIVERSITY DOCTOR OF PHARMACY (PHARM.D) SECTION B PLEASE COMPLETE THIS FORM IN BLOCK LETTERS *Tick where applicable 1. Application for Admission in.. (year) 2. Surname:. Title... First Names: Postal Address:..... Postal Code:.... Home Telephone No.:. Business Telephone No.:... Fax No.:.. address:.. 4. Have you been registered at Rhodes University before?* YES NO If YES please indicate your Rhodes student number: Transcript: Applicants should have submitted by the relevant institution / university their academic transcript(s), reflecting percentages NOT symbols, of all qualifications completed or in progress at the time of submission of this application. A FINAL academic transcript will be required from the relevant institution / university on completion of degrees currently in progress. THE ONUS IS ON THE CANDIDATE TO SUBMIT THE FINAL TRANSCRIPT AS SOON AS POSSIBLE TO THE REGISTAR OR RELEVANT FACULTY OFFICER. Formal Faculty approval will only be given once the final official academic transcript(s) have been received confirming the award of the degree(s). PLEASE INDICATE THE DEGREES YOU HAVE OBTAINED IN THE TABLE BELOW: DEGREE UNIVERSITY YEAR OBTAINED STATEMENT BY THE DEAN OF THE FACULTY: I APPROVE / DO NOT APPROVE the acceptance of this candidate subject to confirmation by the Board of the Faculty, approval by Senate and on the following conditions:.. Admission to status (graduates of other universities):.. SIGNATURE:.. DATE:..

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