Janice K. Loudon PhD, PT, ATC Associate Professor and Post-Professional DPT Program Coordinator

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1 Dear Applicant, Thank you for your interest in the post-professional Doctor of Physical Therapy program at the University of Kansas Medical Center in Kansas City, Kan. Our program has consistently been rated among the leaders in providing quality PT education by national publications and media outlets. Our post-professional graduate program is designed to advance the professional training for an individual holding a degree from a physical therapy program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). The program is designed to provide a strong didactic education in physical therapy; it is not designed to advance clinical hands-on skills. The program includes Web-based courses, online discussion groups, and in some cases, weekend classroom sessions. The applicant must be currently employed as a physical therapist full- or parttime. Admission to KU s DPT program is a competitive process and class size is limited. The faculty values a well-rounded applicant; one who has demonstrated his/her academic and cognitive abilities as well as his/her personal and professional potential. This application packet contains all required materials for acceptance to the DPT program. Please carefully read the instructions and fully complete all forms. Students may enter the program at the beginning of any semester. Applications are accepted during the fall, spring and summer semesters. Completed applications will be processed as they are received. Applicants are notified as soon as the process is complete. Please the Admissions Coordinator, Robert Bagley, at [email protected] if you need any additional information. Sincerely, Janice K. Loudon PhD, PT, ATC Associate Professor and Post-Professional DPT Program Coordinator KUMC subscribes to equal opportunity in its programs and activities. Consequently, it prohibits discrimination based on race, religion, color, sex, disability, national origin, ancestry, sexual orientation and as covered by law, age and veteran status. Physical Therapy & Rehabilitation Science Education Mail Stop Rainbow Blvd. Kansas City, KS Office (913) Fax (913) TDD (913)

2 POST-PROFESSIONAL DOCTOR OF PHYSICAL THERAPY (DPT) DEGREE PROGRAM: DOMESTIC STUDENT APPLICATION PROCEDURE AND CHECKLIST Application Deadline: Varies depending on desired start date Start : Program may begin fall, spring or summer semester Many of the forms can be filled out on your computer prior to printing and we strongly encourage you to take advantage of this feature. Completing your application on the computer prior to printing will expedite your application by eliminating questions or concerns due to illegible handwriting. 1 2 Students need to provide the following items directly to the KU Department of Physical Therapy and Rehabilitation Science: KU Medical Center Domestic Graduate Student Application for Admission This form can be filled out on-screen prior to printing and we strongly encourage you to take advantage of this feature to expedite your application by eliminating questions or concerns due to illegible handwriting. Resume Please provide a resume detailing: - education beyond high school - employment in physical therapy including job title, dates of employment and job responsibilities - honors you have received - professional publications - presentations you have given - membership and participation in professional organizations - other professional credentials or certification programs completed or in progress - continuing education courses in the last 2 years Application fee of $60 Please make payable to University of Kansas Medical Center. This fee is required whether or not you are currently enrolled at the University of Kansas. Your application will not be processed without the fee. Please do not send cash. PT License Please enclose a photocopy of your certificate of physical therapy licensure. Personal Essay Please tell us why you are seeking a Doctor of Physical Therapy and how successful completion of the program will change your practice. Please restrict your answer to five hundred (500) words. Postage-paid Envelopes Please provide two (2) self-addressed stamped no. 10 (business letter) size envelopes. These will be used to communicate with the applicant following receipt of all application materials. These required items are not provided by the applicant directly, but must be requested by the student and received by KU to process the application: Official transcripts One transcript must be sent directly to KU from each college or university attended. Include both undergraduate and graduate records. Graduates from KU s Master of Science in Physical Therapy program do not need to submit a transcript for their course work at KU. Three (3) completed reference forms Two letters from currently practicing physical therapists is recommended. At the top of each of the Personal Recommendation forms, print your name and sign one of the confidentiality options. Distribute the forms, giving the individuals who are writing the recommendations enough notice to thoughtfully complete the form before you plan to send in your application. Instruct them that after they have completed the recommendation, they should put it in an envelope, seal the envelope, sign over the seal, then return the sealed envelope to you. Mail all application documentation to: KU Dept. of Physical Therapy and Rehabilitation Science Education Attn: Post-Professional DPT Admissions Mail Stop Rainbow Blvd. Kansas City, KS NOTE: This application packet is for domestic students only. All required materials must be received before admission to the program. Use the back of this page to briefly explain any item that you did not provide, and return this checklist with the admission packet. Sorry, we cannot process incomplete applications.

3 Term (please select one): KU Medical Center Domestic Graduate Student Application for Admission Please carefully enter information into each field and print two copies when complete; keep one for your personal records. Personal Information Received Fee Rec d Payment Method For KU Use Only First Name Middle Last Name of Birth: MM/DD/YYYY Preferred Name, if different from above Other name(s) under which your records might be found Male Female Social Security Number Home (Current) Address: Social Security Number is required for admission into any program at KU Medical Center for background checks required to verify eligibility to work, train and participate in health care settings. Further, it is requested, but not mandatory under K.S.A , for maintaining accurate records and servicing accounts. Permanent Address (if different from current address): Number and Street Number and Street City & State City & State Country Zip /Postal Code Country Zip /Postal Code Phone Number Mobile Phone Number Phone Number Mobile Phone Number Address Citizenship/Residency Status (please select one): United States Citizen Permanent Resident of United States If you did not select one of the above, STOP: you must use the KU Medical Center International Graduate Student Application. Is English your first language? Yes No If No, what is your first language? Ethnicity Are you Hispanic or Latino? What is your race? Select one or more races. Yes, I am Hispanic or Latino. American Indian or Alaska Native Native Hawaiian or Other Pacific Islander No, I am not Hispanic or Latino. Asian White Black or African American Other NOTE: Disclosure of ethnicity/race information is optional. The University of Kansas has an affirmative action program and is an equal opportunity institution. In order to comply with federal government regulations under Title VI of the Civil Rights Act and Title IX of the Education Amendments, the University seeks voluntary disclosure of information from applicants for reporting purposes only. A decision not to provide this information will not negatively affect decisions on admission, assistantships, or awards. Academic Program Information Department offering degree Degree Academic Program Academic Plan Term: Degree Level Non-degree-seeking Educational Information Applicants must request one (1) official set of transcripts be sent directly from each academic institution attended to the department at KU in which the desired academic program resides. Starting with most recent, please list every higher education institution you have attended. Attach an additional list if needed. Full Name of College/University Full Name of College/University Full Name of College/University City/State City/State City/State Degree Major Degree Major Degree Major To to to s of Awarded GPA s of Awarded GPA s of Awarded GPA Attendance or Expected Attendance or Expected Attendance or Expected (MM/YY) (MM/YY) (MM/YY)

4 Other Information Please check any which apply to you: Current KU/KUMC student Have APPLIED to KU/KUMC before Have ATTENDED KU/KUMC before Member of US Armed Forces, or a dependent of one My parents or I have moved to take a job in Kansas before I enter KU If you have been, or currently are, a student of the University of Kansas (any campus) please enter your student ID: Are you currently a resident of the State of Kansas? Yes No When did you begin continuously living in Kansas? Exam Scores, References and Additional Requirements Additional information and documentation may be required for application to individual academic programs. Please check with the admissions coordinator or Web site of your desired academic program for complete application instructions and requirements. Applicant s I certify that the information given in this application and accompanying documents is complete and accurate, and I understand that submission of incorrect information can be considered sufficient cause for terminating my application or enrollment at the University of Kansas. I hereby grant permission to KU to release applicable personal information, including my social security number, as needed to complete background checks and/or other approval processes for clinical practice. I understand that my admission is conditional upon completion of the background check and that it could provide grounds for rejection of my admission. I further understand and agree that should I be admitted after a background check, that check could be grounds for clinical sites to reject my participation in a clinical training rotation. of Application of Applicant If you have a disability and would like to know about KUMC services, write to: University of Kansas Medical Center, Equal Opportunity Office, Mail Stop 2014, 3901 Rainbow Blvd., Kansas City, KS 66160, USA. Safety and Crime at KU Medical Center: Safety policies, procedures, campus resources, and providing definitions, explanations, and a statistical portrait of crimes on campus can be found at Submit Application Please print, sign and mail this completed application form with the application fee (and any other materials which may be required) to the KU department in which your desired academic program resides. Incomplete or unsigned applications will not be accepted. PLEASE DO NOT WRITE BELOW THIS LINE DEPARTMENTAL RECOMMENDATION Do not admit. Application will not be forwarded to Graduate Studies. Calculation of cumulative GPA from official transcripts GRADUATE STUDIES ACTION admitted in SAKU Admission recommended with status (check only one): Admission granted with status (check only one): Regular Regular non-degree Special B (IGPBS only) Regular Regular non-degree Special B (IGPBS only) Provisional Provisional non-degree Provisional Provisional non-degree Reason(s) for provisional status: Reason(s) for provisional status: Comments/Remarks: Comments/Remarks: Department Graduate Studies

5 Department of Physical Therapy and Rehabilitation Science School of Allied Health The University of Kansas Medical Center Personal Recommendation Applicant's Name Confidentiality Options A. I request a CONFIDENTIAL recommendation and waive my right to review this form. This means that the person who submits this recommendation knows that I will not be aware of its contents now or at any time in the future. B. I request a NON-CONFIDENTIAL recommendation and retain my right to review this form. This means that the person who submits this recommendation knows that I may ask to see this recommendation if I am admitted into the DPT Program. The applicant MUST sign one of the above options Instructions to the person completing this recommendation: The person named above is applying to the Professional Doctor of Physical Therapy Program at the University of Kansas Medical Center. On a separate piece of paper (letterhead, if possible) please: 1) describe your relationship with the candidate; 2) comment on the candidate s ability to communicate (verbally and/or in writing) and his/her interpersonal skills; and 3) address any other qualities this candidate possesses that you believe will enable him/her to be successful in graduate school and become a successful professional. Recommendations from family or friends of the candidate are not accepted. Person Writing the Recommendation (RECOMMENDATION IS TO BE INCLUDED ON AN ATTACHED SHEET; LETTERHEAD PREFERRED). NAME (Print) NAME () CLINICAL and ACADEMIC DEGREES YOU HOLD NAME OF FACILITY/ACADEMIC INSTITUTION YOUR POSITION AT INSTITUTION ADDRESS (CITY/STATE) If the recommendation is to remain confidential (Option A above), please return this form with the accompanying letter to the applicant in a sealed envelope with your signature over the seal to ensure confidentiality.

6 Department of Physical Therapy and Rehabilitation Science School of Allied Health The University of Kansas Medical Center Personal Recommendation Applicant's Name Confidentiality Options A. I request a CONFIDENTIAL recommendation and waive my right to review this form. This means that the person who submits this recommendation knows that I will not be aware of its contents now or at any time in the future. B. I request a NON-CONFIDENTIAL recommendation and retain my right to review this form. This means that the person who submits this recommendation knows that I may ask to see this recommendation if I am admitted into the DPT Program. The applicant MUST sign one of the above options Instructions to the person completing this recommendation: The person named above is applying to the Professional Doctor of Physical Therapy Program at the University of Kansas Medical Center. On a separate piece of paper (letterhead, if possible) please: 1) describe your relationship with the candidate; 2) comment on the candidate s ability to communicate (verbally and/or in writing) and his/her interpersonal skills; and 3) address any other qualities this candidate possesses that you believe will enable him/her to be successful in graduate school and become a successful professional. Recommendations from family or friends of the candidate are not accepted. Person Writing the Recommendation (RECOMMENDATION IS TO BE INCLUDED ON AN ATTACHED SHEET; LETTERHEAD PREFERRED). NAME (Print) NAME () CLINICAL and ACADEMIC DEGREES YOU HOLD NAME OF FACILITY/ACADEMIC INSTITUTION YOUR POSITION AT INSTITUTION ADDRESS (CITY/STATE) If the recommendation is to remain confidential (Option A above), please return this form with the accompanying letter to the applicant in a sealed envelope with your signature over the seal to ensure confidentiality.

7 Department of Physical Therapy and Rehabilitation Science School of Allied Health The University of Kansas Medical Center Personal Recommendation Applicant's Name Confidentiality Options A. I request a CONFIDENTIAL recommendation and waive my right to review this form. This means that the person who submits this recommendation knows that I will not be aware of its contents now or at any time in the future. B. I request a NON-CONFIDENTIAL recommendation and retain my right to review this form. This means that the person who submits this recommendation knows that I may ask to see this recommendation if I am admitted into the DPT Program. The applicant MUST sign one of the above options Instructions to the person completing this recommendation: The person named above is applying to the Professional Doctor of Physical Therapy Program at the University of Kansas Medical Center. On a separate piece of paper (letterhead, if possible) please: 1) describe your relationship with the candidate; 2) comment on the candidate s ability to communicate (verbally and/or in writing) and his/her interpersonal skills; and 3) address any other qualities this candidate possesses that you believe will enable him/her to be successful in graduate school and become a successful professional. Recommendations from family or friends of the candidate are not accepted. Person Writing the Recommendation (RECOMMENDATION IS TO BE INCLUDED ON AN ATTACHED SHEET; LETTERHEAD PREFERRED). NAME (Print) NAME () CLINICAL and ACADEMIC DEGREES YOU HOLD NAME OF FACILITY/ACADEMIC INSTITUTION YOUR POSITION AT INSTITUTION ADDRESS (CITY/STATE) If the recommendation is to remain confidential (Option A above), please return this form with the accompanying letter to the applicant in a sealed envelope with your signature over the seal to ensure confidentiality.