Thomas Jefferson University School of Health Professions Department of Occupational Therapy Non-Matriculant Application Today’s Date: SSN#: Date of Birth: Phone #: First Name: Last Name: Previous Name(s): Address: City: State: Zip: E-mail Address: College/University where you received your Bachelor’s Degree and/or Masters and the year of graduation: College: Year Graduated: College: Year Graduated: TJU OT Alum (yes or no): Year of Graduation: Non-Matriculant entry term/year: September/20 January/20 July/20 May/20 Course(s) selected: If you are planning to take one of the following sequences of courses in the same semester, please list them both below: Autism: OT 761 and OT 762 (Fall semester) or OT 763 and 764 (Spring semester); Neuroscience: OT 751 and 753 (Spring semester); Neurocognitive: OT 742 and OT 743 (Spring semester). You will be billed for one course at a time. Please contact [email protected] if you have any questions. Course Name: Course Number: Course Name: Course Number: Course Name: Course Number: Course Name: Course Number: By signing this application I acknowledge that I have read and understand the conditions of non-matriculant enrollment at Thomas Jefferson University as outlined below. I understand that: As a non-matriculant student I have not been offered admission into a degree program at Thomas Jefferson University. My registration as a non-matriculant student does not guarantee future admission into a Thomas Jefferson University degree program. • Course registration above will generate a tuition payment due on my account; as a student I am responsible for any/all transactions processed • against my current record. As a non-matriculant student I am not eligible for federal financial assistance (Note – you are eligible for grants program described below). • Credits earned while I am a non-matriculant student at Thomas Jefferson University may be applied to a future degree program if applicable. • My enrollment as a non-matriculant student is at the discretion and requires the permission of the occupational therapy department. • • I must apply with a separate application through the Office of Admissions if I want to be considered for a degree program in the future. Department Representative Signature: (to be obtained by Department) Date: Step 1: Complete this application electronically, and e-mail to [email protected] Step 2: If you are interested in applying for an Advanced Education grant, please contact [email protected] If submitting for this grant, please include your CV and 1-page, double-spaced statement of no more than 1000 words describing your potential as a leader and change agent in OT with your non-matriculant application. Also include a copy of your tuition assistance policy and a written statement that describes the amount of support received from your employer.