South Carolina College of Pharmacy Board Application Process USC Campus May 2015 Degree Candidates

Name Information IMPORTANT On ALL documents, list your name EXACTLY as it appears on the government issued ID you plan to present at testing.

College Affidavit and Certification of Clinical Experience – Completed Online The USC campus Dean will be completing the College Affidavit (top of page 6) and Certification of Clinical Experience (page 8) components of the SC Board of Pharmacy Application for Examination for you. The student is responsible for printing and completing the rest of the application. South Carolina application can be found at: http://www.llr.state.sc.us/POL/Pharmacy/PFORMS/Pharmacist%20Application%20by%20Examination.pdf

Application for Examination If you are applying for your license in any other state, let Diane Wise (wise@sccp.sc.edu) know as soon as possible so she can fill out the necessary forms for those states. Also, make sure you look up the deadlines for application for your state as every state’s application process if different. Some states require you to complete an online application. Make sure you have met the hours of practical experience requirements, which may vary according to state. Also be aware of the rules for the hours to be counted and reported to another state. Also, be aware that each state requires you take its version of the MPJE and pay the application fees; factor these expenses into your costs.

SCCP Application Process Concerning Pages 6 and 8 provided by Dean’s Office: Students will be notified by email* after the College Affidavit and Certification of Clinical Experience forms have been completed and are available for pick up in CLS 109. Pages 6 and 8 of the application cannot be provided with the school seal until the student has completed their final rotation, and all grades have been posted and verified. *If you are out of state when you receive your email to pick up your forms, you may email Diane Wise(wise@sccp.sc.edu) and request that they be mailed (you MUST provide your current mailing address). Do NOT have someone else pick your forms up for you.

Practical Experience (Located on Page 4) List practical experience under the supervision of a licensed pharmacist in chronological order. These are your Internship hours, NOT your rotations.

College Clerkship or Rotations (Located on Page 4) There is only room to put 4 of your nine or ten rotations on this section of the form. You may list your first four and below them write in see attached. On a separate sheet of paper list the remaining rotations in chronological order making sure to put your name on the attachment – or write in see attached and then print your rotations from e*value. The e*value document should have your name printed and your rotations listed in chronological order.

Previous Examination Record Previous Licensure as Pharmacist (Located at the middle of Page 4) If the applicant has previously taken the Board examination for pharmacist licensure in this or any other state, he must disclose places, dates and results in the provided spaces if appropriate, or enter N/A. Also, complete the Previous Licensure as a Pharmacist or type N/A.

RECORD OF CHARGES, CONVICTIONS AND FINES IMPOSED ON APPLICANT (Located on Page 5) Please read the instructions and complete the statement as instructed on the form.

Affidavit Section of Form Affidavit Section of Form PROOF OF QUALIFICATIONS (Located on Page 5 under RECORD OF CHARGES, CONVICTIONS AND FINES IMPOSED ON APPLICANT) Have this form notarized by Emily Willingham in CLS-110A, or by other Notary Public. Important: Be sure to sign your form on the line next to Applicant’s Signature. You must sign in the presence of the Notary Public.

Proof of Qualifications Birth Certificates for Students Born In SC You will need a certified copy of your Birth Certificate. Please note, the birth certificate you submit will be returned to you. Birth Certificates may be obtained by contacting: Columbia, SC Office of Vital Records SC DHEC, 2600 Bull Street, Columbia, SC 29201 (803) 898.3630; 8:30am-4pm http://www.scdhec.gov/administration/vr/birth.htm Processing: mail order may take weeks, phone or online will take 5-7 business days, walk-ins will take approx. 1 hour Processing fee of $12-$17 Charleston County Public Health Department 4050 Bridgeview Drive, Suite 475 North Charleston, SC 29405 (843) 746.3801 http://vitalrec.com/sccounties.html#Charleston

Proof of Qualifications Birth Certificates for students born outside of SC You will need a certified copy of your birth certificate. Please note, the birth certificate you submit will be returned to you. Students born outside of South Carolina will need to check in their respective home states for a certified birth certificate. Do not delay as this process could take some time to complete depending on your place of birth. In most cases, a simple online search will direct you to the correct government agency to contact in order to request a birth certificate. Be mindful that there will likely be a fee for requesting the birth certificate.

Character Vouchers (Located on Page 6) Students should have the Character Voucher portion of page 6 completed after receiving the College Affidavit from the College of Pharmacy with the school seal. Character Vouchers A & B must be completed and signed by two licensed pharmacists. The signatures for Character Vouchers A & B must also be the signatures on the (A)(B) lines on the back of the pictures (located on page 7). One picture will be submitted with the completed application. One picture will be presented by the applicant at the time of examination.

Certification of Clinical Experience (Page 8) This form will be completed by the College of Pharmacy and signed by the Dean If you are applying for licensure in another state and not SC, you will still need to send this form to: South Carolina Board of Pharmacy Post Office Box 11927 Columbia, SC 29211-1927 Or you may hand deliver to: 110 Centerview Drive, Suite 201 Columbia, SC 29210

Affidavit of Eligibility (Pages 9 and 10) ALL applicants for a South Carolina license after July 1, 2008, are required to complete and sign the Affidavit of Eligibility. Please check the acceptable secure and verifiable document(s). A copy of the verifiable document(s) must be attached to the Affidavit of Eligibility.

Application Submission Submit your entire Application for Examination to avoid confusion and missing segments. Pay the $100.00 fee. Enclose a Certified copy of your birth certificate. Enclose one picture with signed attachment. *Keep 2nd picture with 2 signatures to present when taking the exam! Enclose Certification of Clinical Experience signed by Dean. Enclose a statement which acknowledges that you have completed the NAPLEX/MPJE registration with the National Association of Boards of Pharmacy (NABP), and be sure to sign your name (see example on following slide). Mail Application to: South Carolina Board of Pharmacy Post Office Box 11927 Columbia, SC 29211-1927 Or, Hand deliver application to: 110 Centerview Drive, Suite 201 Columbia, SC 29210 Once the Application is submitted, students may check the status of their Application on the LLR website. Your application is valid for one year.

Example Statement I, _________________________________________, have completed the registration for the NAPLEX/MPJE with the National Association of Boards of Pharmacy (NABP).  ___________________________ __________ Signature Date  

Application Submission Students may complete the NAPLEX and MPJE registration processes with the National Association of Boards of Pharmacy (NABP) prior to submitting their SC Board of Pharmacy Application for Examination; this is a separate process. NABP will not grant an authorization to test until the graduation date has passed, even though the South Carolina Board of Pharmacy has indicated to them that they have a completed application on file. SCCP degree candidates should select: SC 104 South Carolina College of Pharmacy from the School Code List when submitting their NAPLEX and MPJE registrations.

Application Submission Applications for GA, ALABAMA, NORTH CAROLINA AND TEXAS as well as SOME OTHER STATES WILL NOT BE ACCEPTED UNTIL THE DATE OF GRADUATION OR AFTER GRADUATION. The Dean’s Office will not apply the school seal for these States until the day of Graduation or after . You may pick up the college affidavit portion of these applications when you receive your Diploma (following graduation), from Diane Wise in CLS-109. Make sure you look up the deadlines for application for your state as every state’s application process is different.

Initial Licensure Process After passing the NAPLEX and MPJE, you will receive a Pharmacist’s Initial Licensure Application and an information sheet. Both forms must be completed and submitted along with a $70 initial licensure fee. This process must be completed no more than 30 days after receipt.

Cost Associated with SC Licensure Process MPJE =$210 per state (credit card only) NAPLEX =$505 exam fee (credit card only) Submission fee =$100 (check or money order) Initial Licensure =$70 (check or money order) Application__________________________________ Total for SC =$885 Licensure process