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 OTD-APC@jefferson.edu 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 OTD-APC@Jefferson.edu.
Step 2: If you are interested in applying for an Advanced Education grant, please contact OTD-APC@jefferson.edu.
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.