South Carolina College of PharmacySouth Carolina College of PharmacyBoard Application ProcessBoard Application Process

USC CampusUSC Campus

Name InformationName 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 College Affidavit and Certification of Clinical Experience – Completed OnlineExperience – 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.

The student is responsible for printing and completing the rest of the application.

• South Carolina application can be found:• http://www.llr.state.sc.us/POL/Pharmacy/PFORMS/Pharmacist

%20Licensure%20by%20Exam%20Complete.pdf

Application for ExaminationApplication 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.

SCCP Application ProcessSCCP Application Process

Students will be notified by email after the college affidavit portion and certification of Clinical Experience forms have been completed and are available for pick up in CLS 109.

Application cannot be completed until the student has completed their final rotation .

Cannot receive school seal from office of enrollment services until all grades have been posted and verified.

Completed ApplicationsCompleted Applications

If you are out of state and wish for your forms to be mailed to you, email Diane Wise with the request and current mailing address wise@sccp.sc.edu.

Please do not have someone else pick up your application!

Practical ExperiencePractical Experience(Page 4)(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 College Clerkship or Rotations Rotations

(Page 4)(Page 4)

There is only room to put 4 of your nine or ten rotations on this section of the form.

You may list the first four and below write (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 see attached) and print your rotations from e*value. It will have your name printed and your rotations listed in chronological order.

Previous Examination RecordPrevious Examination RecordPrevious Licensure as Previous Licensure as

PharmacistPharmacist(Page 4: Practical Experience Section)(Page 4: Practical Experience Section)

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 none, type N/A.

RECORD OF CHARGES, CONVICTIONS RECORD OF CHARGES, CONVICTIONS AND FINES IMPOSED ON APPLICANTAND FINES IMPOSED ON APPLICANT

(Page 5)(Page 5)

Please read the instructions and complete the statement as listed on the form.

Affidavit Section of FormAffidavit Section of FormPROOF OF QUALIFICATIONSPROOF OF QUALIFICATIONS

(Page 5: RECORD OF CHARGES, CONVICTIONS AND FINES IMPOSED (Page 5: RECORD OF CHARGES, CONVICTIONS AND FINES IMPOSED ON APPLICANT)ON APPLICANT)

Make sure you sign this portion of the form.

Have form notarized by Emily Willingham in CLS-110A, or other Notary Public.

Proof of QualificationsProof of QualificationsBirth CertificatesBirth Certificates

Have a certified copy of your Birth Certificate. Please note that the birth certificate you submit will NOT be returned.

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.htmProcessing: mail order may take weeks, phone or online will take

5-7 business days, walk-ins will take approx. 1 hourProcessing fee of $12-$17

Charleston County Public Health Department4050 Bridgeview Drive, Suite 475North Charleston, SC 29405(843) 746.3801

http://vitalrec.com/sccounties.html#Charleston

Proof of QualificationsProof of QualificationsBirth CertificatesBirth Certificates

Out of state students 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 request a birth certificate.

Be mindful that there will likely be a fee for requesting the birth certificate.

Character VouchersCharacter Vouchers(Page 6)(Page 6)

Students will have this portion completed after they receive the completed College Affidavit portion from the College 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 (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 Certification of Clinical ExperienceExperience

(Page 8)(Page 8)

Must be completed by the College and signed by the Dean

If you are applying for licensure in another state you will have to complete this form and send 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 EligibilityAffidavit of Eligibility(Page 9 and 10)(Page 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 SubmissionApplication 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 attachment stating you have completed the NAPLEX/MPJE registration with the National Association of Boards of Pharmacy (NABP) sign your name on the attachment (see example on following slide).

Mail Application to: South Carolina Board of Pharmacy

Post Office Box 11927

Columbia, SC 29211-1927

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 StatementExample Statement

I, _________________________________________, have completed the registration for the NAPLEX/MPJE with the National Association of Boards of Pharmacy (NABP). 

___________________________ __________ Signature Date

 

Application SubmissionApplication 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.

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 SubmissionApplication 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. Enrollment Services 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 ProcessInitial 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 Cost Associated with SC Licensure ProcessLicensure ProcessMPJE =$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