Lackawanna College Physical Therapist Assistant Program PTA Application Form (Print Legibly or Type)

Transcription

1 Lackawanna College Physical Therapist Assistant Program Application for Fall (Year) 2014 PTA Application Form (Print Legibly or Type) Information provided on this form will be used to make future contact via phone, , and/or standard mail. Please make sure all information is up to date and correct. This will be the address we will use to contact you for official notification letters or other information. Name: DOB: Maiden Name / Other Names Used (for transcript purposes): Address: Home Phone: Work Phone Cell Phone NOTE: Please advise the PTA Program Director if there is a change in any of the above information, so that we may contact you if additional information is needed. Part 1. Prerequisite Course Work **For an applicant to qualify to apply to the PTA program the prerequisite course must meet one of the two following criteria. 1. If the prerequisite course is a high school course, then the course must have been taken within the last 3 years from the date of application to this program and passed with a C or better 2. If the course is a college level course, then the course must be eligible for transfer to Lackawanna College and passed with a C or better. Anatomy and Physiology must have been a 4 credit course to be eligible to be transferred directly into the PTA program. Prerequisite Course of Biological or Physical Science Only 1 is of the following four courses listed below is needed Anatomy and Physiology (4 credits) Physics Biology Chemistry Year/Semester Completed and Grade Institution where course was completed Currently in Progress

2 Step 2. Past or Current Course Work for possible transfer: Please provide the following information on any college level courses completed or college level courses currently in progress that may be eligible for direct transfer into the PTA program. A course must be passed with a C or better to be eligible for Transfer Computer Applications courses must have been taken within the last 5 years to be eligible for transfer Course Anatomy and Physiology (4 credits) College Writing Math (college algebra or higher) Psychology Intro to Computer Applications Effective Speaking Medical Ethics Medical Terminology Year/Semester Completed and Grade Institution where course was completed Currently in Progress Part 3. Transcripts: Submit an official sealed copy of all transcripts (both high school and college) for institutions previously attended even if a degree was not completed. Send directly to the Lackawanna College's Lake Region Center. Lackawanna College Lake Region Center 8 Silk Mill Drive Hawley, PA SAT or ACT: If the SAT or ACT examination has been completed please list the scores if available below. Forward official copies of test scores to the LC Lake Region Center or Main Campus. Verbal/English Score Math Score Please list below all colleges or universities currently attending or previously attended with dates attended and degrees earned if any. 1. From: To: 2. From: To: 3. From: To:

3 Part 4. Past Work Experience: Please describe your work experience over the past 10 years, beginning with current or most recent employment. Please use and attach additional paper if necessary. ** Continue on the back of this page of application if more space is needed. 1. ( ) 2. ( ) 3. ( ) 4. ( ) Part 5. REFERENCES: Print out 3 reference forms from the PTA program web page. These forms are to be provided to your references who will then mail the completed form, along with a written statement about you, directly to the LC PTA Program. It is suggested that you provide a self-addressed stamped envelope with the reference sheet to the individuals you are requesting a recommendation from. The PTA program address is provided on the final page of this application, as well as the official reference form. Follow all instructions listed on the reference form which again can be downloaded from the PTA program web site, and provided to the individuals who will complete them. Family members or close personal friends are not permitted for use as references. It is recommended but not required that you provide a reference from: 1) An educator 2) A former or current employer or supervisor 3) An individual of your choice other than a family member Please list the names of the individuals providing the references below. This will allow us to confirm receipt of each of your references as they arrive directly to us. 1. Title or Relationship 2. Title or Relationship 3. Title or Relationship

4 Part 6. Reflective Papers (Essays): Two short essays are required to be submitted with your application for admission to the Physical Therapist Assistant (PTA) Program. Please follow strictly to the format listed below. Inability to follow specific directions will be considered while reviewing your essays/application. 1. No more than 2 to 3 pages in length 2. Using size 11 Times New Roman font 3. No greater than 1 ½ line spacing 4. Standard 1 margins. 5. Please include your name on each page. Essay 1 (required by all applicants) Think of the attributes or characteristics that you look for in health care professional. Describe why an individual with those attributes makes a good health care professional. Also then identify the qualities you feel you yourself possess, and describe how they will enhance your role as a student within this program and a future medical professional. Essay 2 (choose either 1 of the following 2 essays) 1. Please provide an example, and summarize your understanding of a current issue related the profession of Physical Therapy, or directly related to Physical Therapist Assistants. This may be something related to advances within the profession, legal issues, billing and insurance issues or other current relevant topics. 2. Please explain in detail something particular you experienced during your clinical observation hours and describe how that experience has strengthened your desire to further pursue a career as a physical therapist assistant. (please adhere to confidentiality guidelines by NOT identifying patients, therapists, or facilities by name) Your essay will be scored with an essay rubric looking at the following items: o Content / Focus Ie. did you thoroughly address the topic of the essay as previously described above o Organization / Development o Vocabulary o Mechanics, Format, and Language Use Each area will be scored using the following scale and a final essay score recorded very poor 2 below average 4 average 6 above average 8 excellent Part 7. Informational Session: Attendance is required at an informational session prior to entry into this program. They are offered separately or during an open house weekend at various times throughout the calendar year. The informational session will provide you with further details regarding this program including but not limited to, applying to this program, the expectations of the program, program progression and curriculum, and our current Accreditation Status. We encourage you to bring questions regarding any aspect of this program from application and admission to graduation. We want you to have as much information provided to make a well informed decision regarding your future education. Several dates and times will be made available to accommodate scheduling needs of the applicants. Parents, legal guardians, and spouses are encouraged and welcome to attend. If you are unable to attend one of the schedule sessions held throughout the year you may contact the PTA Program Director to set up a personal meeting to discuss program information. PTA Program Director Ext 2608

5 Part 8. Interviews: The personal interview process is the final process by which the PTA program faculty will have a chance to directly interact and get to know you as individual. We consider this a "professional interview" and highly take into consideration all aspects of the interview process including the applicant's ability to interact with the faculty. For an applicant to be considered for invitation for the final interview process, their completed application packet must be received by the March 1 st deadline. Application packets not deemed bona fide or complete (including receipt of reference letters by the deadline) will not be considered. If an individual's application is deemed complete they may be invited for a formal interview which will be conducted with at least the PTA Program Director, ACCE and Assistant ACCE. Acceptance of a full application packet does not guarantee an offer of an interview. Applicants being offered an interview will receive a letter by mail, or in certain circumstances a phone call to provide them with the specific date and time of the personal interview. Interviews will last approximately 45 minutes to an hour with no other friend or family members present directly within the interview. A waiting area is provided for those individuals in accompaniment. 1. Please arrive appropriately dressed and on time for your interview 2. Provide a passport size photo to interviewers at the time of your arrival to be included in your application file. 3. Interview dates and times are offered based on the availability of all faculty members. Requests for changes to a date or time will considered based on extreme circumstances and must be requested directly to the PTA Program Director. 4. The offering of an interview is in no way a guarantee of acceptance into the PTA program. If accepted into the Physical Therapist Assistant (PTA) Program. Following acceptance into the PTA program there will be further requested items that must be completed and handed in to the PTA program prior to entry into the fall term. Items will include but not be limited to: 1. Proof of current Adult, Child, and Infant CPR certification and AED training. Provide a photocopy of the front and back of current card/s. All courses must be in person and can NOT be completed as an online course. 2. Proof of current health insurance is required for entry into the program. (copy of front and back of insurance card) 3. Copies of a recent physical and full immunization records 4. All required background checks and clearances described in your acceptance packet. 5. Mandatory drug screenings. Paper work with full instructions will be provided with an acceptance packet 6. PPD test confirmation 7. Other items to with full instructions provided within acceptance packet. Official Transcripts, SAT and ACT scores please have sent directly to Lackawanna College. All other application materials including essays, reference forms, observational hour verification forms, and copies of any other requested materials should be sent directly to: C/O Dr. Michael Augustine, PTA Program Director Lackawanna College Lake Region Center 8 Silk Mill Drive Hawley, PA 18428