DOCTOR OF PHYSICAL THERAPY PROGRAM

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1 GRADUATE ADMISSION APPLICATION DOCTOR OF PHYSICAL THERAPY PROGRAM Saint Francis University Stokes Building, Suite 229 PO Box 600 Loretto, PA 1590 (81) FAX (81) Reach higher go far

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3 Doctor of Physical Therapy Graduate Admissions Application Mail to: Saint Francis University Graduate Admissions Committee PO Box 600 Loretto, PA 1590 Instructions 1. Return the completed application with the $30 (non-refundable) application fee to the above address. Make check payable to Saint Francis University. 2. Request official transcripts from all baccalaureate and post-baccalaureate institutions attended. Transcripts must be submitted to the above address in sealed envelopes, or they will not be considered official. (International students should refer to next page for further instructions.) 3. Submit the Documentation Form for Physical Therapy Clinical Volunteer/Paid Employment Experience. Saint Francis University requires a minimum of eighty (80) hours in two different physical therapy settings with a minimum of ten (10) hours in each. This form may be copied as needed.. Submit brief typed essay (300 words or less) ~ Describe your personal characteristics that you believe will lead to your success in the physical therapy profession. 5. Submit three professional recommendations (two from physical therapists and one other) using the Professional Recommendation Forms provided. These recommendations must be submitted to the Admissions Committee directly from the references in sealed envelopes. 6. Submit completed Prerequisite Check-off form provided in the application packet. 7. Submit completed Current Course Enrollment form provided in the application packet. Please Print or Type Name: Social Security No. (Last, First, Middle) Please list other name(s) which may have previously appeared on academic records: Mailing address: Permanent Address: Home Telephone: ( ) Permanent Telephone: ( ) Male Female Date of Birth / / month/date/year Citizenship: U.S. Citizen U.S. Permanent Resident Other Visa type If Other, Country of Citizenship: Applying to Start: Summer - Year Physical Therapist Assistants Have you successfully completed a Physical Therapist Assistant program? Yes No Professional School: Date Completed:

4 Academic History Please list all colleges and universities you have attended regardless of whether you finished a degree program, beginning with the most recent. One official transcript from each of these institutions must be submitted. If you are currently completing your bachelor s degree, please list the institution, state the degree you are pursuing and month and year you anticipate completion. Name of Institution Location (city, state) Area of Study Dates Attended Degree Awarded If additional space is needed, please attach a supplementary sheet; include your name and staple it to this application form. Racial/Ethnic Background This information is for statistical purposes only and has no bearing on admission to the University. Response is optional. Non-resident alien Hispanic/Latino White Asian Two or more races Black or African American American Indian or Alaskan Native Unknown Native Hawaiian or other Pacific Islander International Students International applicants must submit satisfactory scores from the Test of English as a Foreign Language (T.O.E.F.L.). Applicants whose native language is English are exempt from this requirement. International students must send their transcripts to an international agency where the transcripts will be converted to the American academic scale. International applicants must also submit an affidavit of financial support after acceptance to the University. Instructions about this disclosure may be obtained by calling the Office of Admissions at International students should apply for admission and the required testing well in advance in order to ensure evaluation of their credentials in a time frame which is equitable to themselves and the Admissions Committee. TOEFL Score: Signature of Applicant I certify that the information provided by me is accurate and complete to the best of my knowledge and understand that all records become the property of Saint Francis University and cannot be returned to the applicant nor forwarded to a third party. Applicant Signature Date Statement of Nondiscrimination and No Harassment Policy Saint Francis University, inspired by its Franciscan and Catholic identity, values equality of opportunity, human dignity, racial, cultural and ethnic diversity, both as an educational institution and as an employer. Accordingly, the University prohibits and does not engage in discrimination or harassment on the basis of gender, age, race, color, ethnicity, religion, sexual orientation, marital status, disability, veteran status, or any protected classification. The University is committed to this policy based upon its values and in compliance with federal and state laws. This policy applies to all programs and activities of the University, including, but not limited to, admission and employment practices, educational policies, scholarship and loan programs and athletic or other University sponsored programs. Questions regarding this policy may be addressed to the Institutional Compliance Officer/Affirmative Action/Title IX/Section 50 Coordinator, Saint Francis University, 102 Raymond Hall, Loretto, PA 1590 (81) Effective: April 1, 2010

5 Saint Francis University Graduate Admissions Committee Stokes Building, Suite 229, PO Box 600 Loretto, PA (81) Prerequisite Check-off Form Applicant s Name: (Last) (First) (Initial) Social Security No. (last four digits for verification) Directions 1. List when and where you have taken or are taking each prerequisite, the number of credits for the course, the quality points and the grade received. 2. Calculate your Math/Science Prerequisites, a minimum cumulative grade point average of 3.0 (.0 scale) **(see back of form for scale) to be considered for the DPT Program. No grade in any prerequisite course below C will be accepted. 3. Applicants who believe they have taken an equivalent of the course(s) must provide the appropriate course descriptions and/or course syllabi with their application to determination course equivalency. Please leave grade and quality point columns blank for courses that have not been completed.. An official transcript must be submitted with prerequisite form. Prerequisite Coursework: See course descriptions provided. Prerequisite Dept/No. Institution Term/Year Taken/Taking General Biology Anatomy & Physiology 1. Credits Quality Points Grade 2. Exercise Physiology Chemistry Physics Statistics 3 Intro. Psychology Other Psychology Cumulative Math/Science GPA Signature of Applicant: Date: OFFICE USE ONLY OVERALL QPA PREREQUISITE QPA Verified: Graduate Admissions Committee

6 Description of Prerequisite Courses for Admissions Descriptions for the prerequisite coursework for graduate admission to the Doctor of Physical Therapy program are provided below. Applicants who believe they have taken an equivalent of the course(s) must provide the appropriate course descriptions and/or course syllabi with their application so that the Graduate Admissions Committee can make a determination of equivalency. Contact Ms. Lisa Buck, coordinator of graduate admissions, if you have any questions at (81) or Prerequisite Credits Description General Biology One course offered by a Biology Department that includes a laboratory portion. Anatomy & Physiology 8 A two-course sequence (with labs) addressing the structure and function of the human mammalian body studied at the cellular, tissue, and organ level of organization. Invertebrate Anatomy & Physiology is not acceptable. Exercise Physiology Chemistry Physics The study of the normal physiological responses to, and the recovery from acute and chronic exercise stresses in the trained and untrained individual. A lab component is required. 8 A two-course introductory sequence (with labs) that covers basic concepts, theories and application of chemistry. 8 A two-course sequence (with labs) that covers fundamentals of physics, classical and modern, including mechanics, heat, light, electricity, magnetism, and modern physics. Introductory Psychology 3 A foundational course which covers the major areas of study within psychology. Psychology 6 Two courses that examine specific areas of psychological theory and practice. Such courses include: Sensation and Perception; Learning; Abnormal Psychology; Cognition; Physiological Psychology; and Developmental Psychology. Statistics 3 A course which covers the collection, presentation, analysis and interpretation of data. ** The Q.P.A. is determined by dividing the total number of quality points earned by the total number of credits taken for grade. Each letter grade earns quality points as described in the example provided below. Plus and minus modifiers are authorized only for the A-, B+, B-, and C+. The Quality Point Average in the following example is 66/27 = 2. Grade Point Value Course Credits Quality Points A x 3 12 A x 3 11 B x 3 10 B 3 x 3 9 B x 3 8 C x 3 7 C 2 x 3 6 D 1 x 3 3 F 0 x

7 Saint Francis University Graduate Admissions Committee Stokes Building, Suite 229 PO Box 600 Loretto, PA (81) Current Course Enrollment Form Applicant s Name: (Last) (First) (Initial) Social Security No. (last four digits for verification) Semester: (check one) FALL SPRING/WINTER SUMMER I am currently attending another college/university and am enrolled in the following courses. I will not be taking any courses this semester. Dept. No. Course Title Institution Credits Expected date of completion: Semester: (check one) FALL SPRING/WINTER SUMMER I am currently attending another college/university and am enrolled in the following courses. I will not be taking any courses this semester. Dept. No. Course Title Institution Credits Expected date of completion: Signature of Applicant: Date:

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9 Saint Francis University Graduate Admissions Committee Stokes Building, Suite 229 PO Box 600 Loretto, PA (81) Professional Recommendation Form TO BE COMPLETED BY THE APPLICANT: Applicant s Name: (Last) (First) (Initial) Social Security No. (last four digits for verification) Please check and sign below: I hereby waive do not waive my right to have access to this evaluation form required for admission to the Saint Francis University physical therapy program. Signature of Applicant: Date: (If no check is made above, the Graduate Admissions Committee assumes that you do not waive access.) TO BE COMPLETED BY THE EVALUATOR (Part 1): Name of Evaluator: (please print) Position / Title: Address: Daytime Telephone: ( ) Please check and sign below: This evaluation is submitted with understanding that the applicant has has not waived access as indicated above. SIGNATURE: DATE: Page 1 of 2

10 TO BE COMPLETED BY THE EVALUATOR (Part 2): Name of Applicant: Name of Evaluator: 1. In what capacity did/do you work with the applicant? 2. How long have you known the applicant? 3. Please rate the applicant on the following grid relative to others that you have known in the same capacity in recent years. Academic Performance Interpersonal Skills (Ability to relate to others) Motivation for pursuing a career as a health professional Personal Maturity Adaptability / Flexibility Exceptional Good Average Below Average Cannot Evaluate. Please comment on the applicant s ability to relate constructively and diplomatically with other people. 5. What are the applicant s greatest strengths relative to a career as a physical therapist/health professional? 6. What are the applicant s greatest weaknesses relative to a career as a physical therapist/health professional? Please feel free to make any further comments that you would like the Graduate Admissions Committee to consider in making its decision regarding this applicant on a separate sheet of paper. SIGNATURE: DATE: Page 2 of 2

11 Saint Francis University Graduate Admissions Committee PO Box 600 Loretto, PA (81) Documentation Form for Physical Therapy Clinical Volunteer/Paid Employment Experience (PLEASE PRINT) APPLICANT NAME: SOCIAL SECURITY NO. (last four digits for verification) APPLICANT SIGNATURE: DATE: The person named above is an applicant to the Physical Therapy program at Saint Francis University. All applicants are required to document completion of at least 80 hours of clinical experience. By completing this form, you are verifying that the applicant was supervised by a physical therapist as a volunteer or paid employee. This form requires the signature of a physical therapist. NAME OF CLINICAL FACILITY: ADDRESS: TELEPHONE: ( ) PRACTICE SETTING: acute care/hospital inpatient rehab nursing home out patient other: hours of experience were completed as a: volunteer employee INCLUSIVE DATES: Please indicate the typical responsibilities assumed by this applicant: (check all that apply) 1. observed: patient evaluations patient treatment 2. assisted with: basic exercise programs gait training patient transfers 3. prepared: patient for treatment treatment area modalities. general housekeeping 5. clean treatment areas 6. other: (briefly describe) NAME OF PHYSICAL THERAPIST: (please print) POSITION / TITLE: SIGNATURE: DATE: Applicant may photocopy as necessary.

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