OREGON HEALTH & SCIENCE UNIVERSITY Physician Assistant Program Supplemental Application Form Must Be Submitted Online

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1 OREGON HEALTH & SCIENCE UNIVERSITY Physician Assistant Program Supplemental Application Form Must Be Submitted Online This document is provided as a guide for completing the online supplemental application and cannot be used in lieu of online submission of the supplemental. Please use the following information for planning your responses to the supplemental questions. SECTION 1 PLEASE PROVIDE THE FOLLOWING INFORMATION. CASPA ID #: Address: Have you previously applied for admission to the OHSU PA Program? If yes, specify year(s): Before 2010, , , CRIMINAL BACKGROUND INFORMATION (required of all applicants): The Physician Assistant Program reserves the right to deny admission to any applicant whose criminal background poses a threat to the university, physician assistant profession, and/or health care community. Please answer the following questions. Have you ever been convicted of a felony or misdemeanor? Have you ever been found guilty except for insanity, mental disease, defect, etc. or not guilty by reason of insanity, mental disease, defect, etc. in any proceedings in which you were charged with a felony or misdemeanor? Do you currently have an arrest pending for a felony or misdemeanor? If the answer to any of the above questions is Yes please indicate the crime involved, any sentence imposed, and the year(s), state, county, and country in which the legal proceedings took place. Should the answer to any of the above questions become Yes between the time of submission of this application and an applicant s enrollment at OHSU, the individual must immediately inform the Director of the Physician Assistant Program. SECTION 2 ADDITIONAL INFORMATION As a program within the OHSU School of Medicine, we have been asked to collect additional data on applicants to determine Oregon ties not captured in CASPA. The PA Program acknowledges we have a national applicant pool, so answers to items 2a-2c are optional: a. Did you graduate from high school in Oregon with at least two years of enrollment? Y/N b. Did you graduate an institution of higher education in Oregon with at least two years in that institution? Y/N c. Do one or both parents reside in Oregon at the time of this application? Y/N

2 d. Physician Assistant students interact with patients from many backgrounds. Indicate any language(s) other than English in which you feel comfortable conversing. Please provide a brief summary of your foreign language skills. Answers to 2d are optional. You are able to list up to two language skills using the following format: Language (Spanish, Russian, French, German, Vietnamese, Other, N/A) (if other is selected, you will be able to enter the language) Fluency (fluent, conversational, minimal, N/A) Highest Level (high school, college, immersion, native language, other, N/A) Years (Less than 1 year, 1-4 years, 5+ years, N/A) SECTION 3 PREREQUISITE COURSEWORK (required) Please enter the courses you deem appropriate to meet the prerequisites. The following prerequisite completion form can be used as a template and guide for meeting our prerequisites. To be eligible for 2014 admissions, ALL PREREQUISITE COURSEWORK MUST BE COMPLETE ON OR BEFORE DECEMBER 31, If you are currently enrolled in a course or plan to take it by the deadline, please indicate the date the course will be completed. A grade of C or above is required to meet all prerequisites. Candidates may have their bachelor s degree in progress as long as it is complete by spring 2014 (degree verification must show degree conferred prior to matriculation) and all prerequisites complete on or before the end of fall term No exceptions.

3 Prerequisite Inventory: (to be used as a guide for entering courses into online version) Bachelor s Degree required completion by the end of spring term 2014 Degree: Major: Degree Date: Biology General, Cell, Molecular, Genetics labs optional (2 semesters or 3 quarters) Grade Date Completed or Chemistry - General, Inorganic, Organic, Biochem labs optional (2 semesters or 3 quarters) Grade Date Completed or Microbiology with Lab (lab required) (one course with lab) (International Grads must meet this requirement at a U.S. or Canadian institution) Grade Date Completed or Human Anatomy & Physiology with Lab - Minimum of 2 semesters of a combined A&P w/lab OR 3 quarters of a combined A&P w/lab OR one semester each of anatomy w/ lab and physiology w/ lab. For 2014 admissions, transcripts must show A&P w/lab successfully completed summer 2007 or later. Note: Online A&P with labs will not be accepted. A&P w/lab requirement must be completed within 7 years of planned matriculation - If A&P w/lab was taken in winter/spring 2007 or earlier, then a minimum of one quarter or one semester of A&P w/lab is required (prefer refresher of 2 quarters or 2 semesters) Please show plan to take additional A&P w/lab if your A&P w/lab needs a refresher. (International Grads must meet this requirement at U.S. or Canadian institution) Grade Date Completed or General or Developmental Psychology (one course) Grade Date Completed or Statistics or Biostatistics (one course; offered through statistics, math, psychology, or sociology depts) Grade Date Completed or

4 SECTION 4 SUPPLEMENTAL NARRATIVES (answers to 4A-4D are required for all applicants; 4E is required for applicants who have previously applied to the OHSU PA Program) All first-time OHSU applicants: Please respond to the following (A, B, C, D) in concise typewritten statements. One or two paragraph responses per statement will be sufficient. Reapplicants to OHSU: Please respond to For reapplicants only question (E) and provide updated answers to questions A-D. A. Describe your specific interest in the OHSU PA Program. B. You are talking with a friend about your application to PA programs. Unsure exactly what a PA is, they ask you is that something like a nurse, or a doctor in training? How would you respond? C. Please describe your interactions, if any, with clinically practicing physician assistants. If you have not interacted with a PA, please describe resources you found useful in your quest to learn more about the PA profession. D. The OHSU PA Program strives to create a class of individuals with varied backgrounds and interests. If accepted, what would you see as your greatest potential contribution to the class? E. For reapplicants only: You are highly encouraged to update the admissions committee on your previous year s supplemental application answers to (A-D) above. In addition to updates, please focus your answer for E to the following question: In planning for your reapplication this year, what specific aspects of last year s application did you feel could be improved upon? Specifically, please detail efforts you have made (or plan to make) in the intervening year to make yourself a more competitive applicant; mention additional PA resources you may have utilized, and expand upon your continued interest in the OHSU PA Program. If you previously interviewed with the program before, feel free to discuss thoughts regarding the interview. (Your answer to E may utilize up to a full page response.) OHSU is an equal opportunity affirmative action institution. OHSU provides equal opportunities to all individuals without regard to race, color, religion, national origin, disability, age, marital status, sex, sexual orientation, gender identity or expression, military service, or any other status protected by law. It does not discriminate on any status protected by law. This policy applies to all employment, education, volunteer, and patient care related activities or in any other aspect of OHSU s operation. Such compliance efforts are coordinated by the OHSU Affirmative Action and Equal Opportunity (AAEO) Department. OHSU complies with Title IX of the Education Amendments Act of 1972 and 34 CFR Part 106 by prohibiting discrimination on the basis of sex or gender in education programs, activities, employment, and admissions. Inquiries about Title IX compliance or sex/gender discrimination may be directed to the OHSU Title IX Coordinator: Michael Tom, AAEO Director, , Mailing address: Mail code MP240, 3181 SW Sam Jackson Park Rd, Portland, OR Office: Marquam Plaza Suite 240, 2525 SW 3rd Ave, Portland, OR AAEO website: Title IX inquiries may also be directed to the U.S. Department of Education Office for Civil Rights,

5 OREGON HEALTH & SCIENCE UNIVERSITY Technical Standards Health Sciences programs have a societal responsibility to train competent healthcare providers and scientists that demonstrate critical judgment, extensive knowledge and well-honed technical skills. All candidates for an OHSU degree or certificate must possess essential skills and abilities necessary to complete the curriculum successfully. These include academic (e.g., examination scores, grade point average) as well as technical standards. These technical standards are nonacademic criteria, basic to all of OHSU s educational programs. Each OHSU program may develop more specific technical standards. Please see page five for PA Program Technical Standards. OHSU s Technical Standards include: Acquire information from experiences and demonstrations conveyed through online coursework, lecture, group seminar, small group activities, and other. Ability to recognize, understand and interpret required instruction materials including written documents, computer-information systems, and non-book resources. Ability to manipulate the equipment, instruments, apparatus, or tools required to collect and interpret data appropriate to the domain of study, practice or research. Ability to follow universal precautions against contamination and cross contamination with infectious pathogens, toxins and other hazardous chemicals. Solve problems and think critically to develop appropriate products and services (e.g., treatment plan, a scientific experiment.) Synthesize information to develop and defend conclusions regarding observations and outcomes Use intellectual ability, exercise proper judgment, and complete all responsibilities within a timeframe that is appropriate to a given setting. Maintain effective, mature, and sensitive relationships under all circumstances (e.g., clients, patients, students, faculty, staff and other professionals.) Communicate effectively and efficiently with faculty, colleagues, and all other persons encountered in any OHSU setting. Work in a safe manner and respond appropriately to emergencies and urgencies. Demonstrate emotional stability to function effectively under stress and adapt to changing environments inherent in clinical practice, health care and biomedical sciences and engineering. Disabilities: It is our experience that a number of individuals with disabilities, as defined by Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, are qualified to study and work as health care professionals and scientists with the use of reasonable accommodations. To be qualified for health sciences programs at OHSU those individuals must be able to meet both our academic standards and the technical standards, with or without reasonable accommodations. For further information regarding services and resources for students with disabilities and/or to request accommodations, please contact the Office for Student Access. Approved: October 30, 2009

6 OREGON HEALTH & SCIENCE UNIVERSITY School of Medicine Division of Physician Assistant Education Technical Standards For successful completion of the course of study for the degree of Master of Physician Assistant Studies at OHSU, candidates for graduation must possess the knowledge, skills, attitudes and judgment to function in a broad variety of clinical situations and to render a wide spectrum of patient care. Candidates must demonstrate the capacity to develop academic and emotional maturity and leadership skills to function effectively in a medical team. Therefore, all students admitted to the Program must be able to meet, with or without reasonable accommodation, the following abilities and expectations. Students/applicants who may have questions regarding these technical standards or who believe they may need to request reasonable accommodation in order to meet the standards are encouraged to contact the Office for Student Access. 1. Candidates must be able to observe demonstrations and experiments in the basic sciences. 2. Candidates must have sufficient use of the sensory, vision, hearing, motor and somatic sensation necessary to perform a physical examination. Candidates must be able to perform activities such as palpation, auscultation, percussion, the administration of intravenous medication, the application of pressure to stop bleeding, the opening of obstructed airways, and the movements, equilibrium and functional use of the sense of touch and vision. 3. Candidates must be able to learn to respond with precise, quick and appropriate action in emergency situations. 4. Candidates must be able to communicate with accuracy, clarity, efficiency and sensitivity. 5. Candidates must have the skills to be able to analyze and synthesize information, solve problems, and reach diagnostic and therapeutic judgments. 6. Candidates must be able to acknowledge evaluation and respond appropriately. 7. Candidates must possess the interpersonal skills to develop rapport and positive relationships with patients. 8. Candidates are expected to possess the perseverance, diligence and consistency to complete the PA Program curriculum. Candidates, therefore, must be able to tolerate physically taxing workloads, to function effectively under stress, to adapt to changing environments, to display flexibility, and to function in the face of uncertainties inherent in the clinical problems of many patients.

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