Thank you for your interest in our Congrats Committee! Please complete the short questionnaire below to participate.

More questions about the program? Please contact Jordana Berry, Director of Admissions: berry_js@mercer.edu; 678-547-6182.

1.Name

First

Last

Maiden (if applicable)

2.Year of Graduation

3.Home Address

Address

City

State

Zip

4.Preferred Email Address

5.Preferred Phone #

Sometimes you may be paired with an accepted student in your area or one with a similar background/interests and other times, the pairing will be random. Please share with us any information that you feel may be helpful in pairing you with an accepted student.

6.What is your hometown/state?

7.Where did you complete your pharmacy prerequisites?

8.Please tell us a little bit about your career. By sharing your employer, title and practice setting, we can work to pair you with a student who has similar interests.

9.Please check the below statements that apply to you:

I was a Pharmacy Tech before attending pharmacy school.

I completed a dual degree.

I was the first person in my family to attend college.

I moved from out of town/state to attend pharmacy school.

Pharmacy school was a career change for me.

I balanced family responsibilities with school work (e.g., caregiving, parenting, head of household, etc.).

10.Is there anything else you would like to share that would be helpful in pairing you with a student?