SWOSU RxPath Registration Form

SWOSU RxPath Registration Form
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
High school attended:
High school city & state:
Expected graduation date:
Current overall high school GPA:
Highest ACT composite score:
Leave blank if you have not taken the ACT exam.
Highest SAT combined score:
Leave blank if you have not taken the SAT exam.
Name(s) of parent(s) or legal guardian(s)
Have you attended any workshop event at the SWOSU College of Pharmacy?
If "yes", please list the event attended:
Have you job shadowed or worked in a pharmacy?
If "yes", please list the name and location of the pharmacy in which you worked/shadowed as well as the approximate number of hours:
Please describe below why you are interested in becoming a pharmacist:
Should be Empty: