Physical Therapist Assistant Application Checklist Application ...

Physical Therapist Assistant Application ChecklistApplication Deadline: April 1, 2013*Please check off the following items as they are completed in order to be aneligible candidate for our Allied Health Programs.1. ___ I have applied to Tarrant County College through a TCC campus registrar, oronline at http://www.tccd.edu/Admissions/Apply.html.2. ___ I have read the entire ‘Selective Admissions Information Packet’ included in thispacket, and will SUBMT Online, or deliver to Trinity River East Campus (by mail or inperson) my signed application materials before the application deadline.Address: TCC-Trinity River East Campus – Allied Health Dept.TRHN 3211245 E. Belknap St.Fort Worth, TX 76102-19013. ___ I have provided Current Official transcripts from ALL colleges and schoolsattended to the TCC Registrar. For transcript submission follow-up, I can contact theTCC registrar at 817-515-1051.• Provide official high school transcripts ONLY if you have not yet attended collegeor will have less than 12 semester college hours by the application deadline.• If you are planning to submit an international (out of the U.S.) transcript, firstcontact the TCC International Admissions Office at 817-515-5232 to schedule anappointment. Start this process at least eight (8) weeks before the deadline date.4. ___ I verify that my submitted documentation shows competency in intermediatealgebra, reading and writing skills. I have demonstrated this competency in one ofthe following ways:• Completion of previous applicable coursework, or• Passing the intermediate math, reading and writing sections of the THEA orACCUPLACER tests (or an appropriate alternative test), or• Earning a grade of C or higher in MATH 0350 or MATH 0109, RDNG 0363 andENGL0325.5. ___ I verify that all required immunization requirements listed in the attached‘Selective Admissions Information Packet’ have been started, AND will becompleted no later than the first day of classes.6. ___ I acknowledge that I will be required to pass a Drug Screening and BackgroundCheck upon admission to this program. I also acknowledge that these requiredchecks will be administered within 30 days prior to my starting program clinicalrotations. If I fail either of these protocols, I acknowledge that I will be dismissedfrom the program.7. ___(If Applicable) I have submitted my criminal history evaluation results to theDirector of Allied Health. Please use the address listed above for item number (2).**Applicants are encouraged to call the Allied Health Department prior to the deadline date tosee if all materials have been received. They can be reached at 817-515-2481 or atAllied.Health@tccd.edu.By signing below, I verify that I have read and understood that I am responsible forproviding, and meeting, the criteria listed in this document. If it is discovered that any ofthe information I have provided for application has been falsified, I will be respectfullydismissed from the program.________________________________________________________________Student SignatureDateTarrant County College is an Equal Opportunity institution that provides educational and employmentopportunities on the basis of merit and without discrimination because of race, color, religion, sex, age,national origin, veteran status or disability.

Tarrant County CollegeAPPLICATION FOR ADMISSIONAllied Health Programs - Physical Therapist AssistantFor Program Beginning Fall Semester 2013Deadline to Submit all application materials: 5:00 pm, April 1, 2013Submit application materials online, in person, or by mail:Tarrant County College Trinity River East CampusAllied Health DepartmentAttn: Physical Therapist Assistant245 E. Belknap StFort Worth, TX 76102-1901Application materials include:Program application (if not submitted on-line)Completed Application ChecklistAFS approval, if applicable*NOTE - Current Offical Transcripts, from allcolleges attended, must be submitted to TCCregistrar by the deadline date.Check here if you have previously applied to ANY Allied Health Program at TCC.Program and date of application if you checked above:If you have participated in a previous Allied Health Program at Tarrant County College but did not complete that program, youmust attach a letter from that Program Coordinator stating that you are eligible for application.Name:Last First Middle Other (e.g. maiden name)Current Address:StreetCity State Zip CountyID:Email:Colleague ID#Phone Numbers: Home/ Work/ Cell/YesNoHave you applied to Tarrant County College?You must apply to TCC and also submit official transcripts to theregistrar's office from all colleges you have attended. Failure to apply toTCC will result in ineligibility for Allied Health Program selection.YesYesYesYesNoNoNoNoDo you have less than 12 semester college hours?If "yes," you are required to turn in your official High School Transcriptor GED with Score Report. If "no," you will need to submit ALL officialcollege transcripts only.Are you applying under AFS/Academic Fresh Start?If you selected "yes," attach a copy of the AFS paperwork. AFS applicantsmust fulfill the competency requirements for Reading, Writing and Mathwith current coursework or with THEA or ACCUPLACER testing.If you are applying under AFS at which campus did you apply? AFS isinstitution specific; you must apply at TCC even if you have applied forAFS at another Texas college.Date/campus of AFS at TCC, if applicable.Are you applying with International Transcripts?If you selected "yes," attach a copy of the TCC International Evaluation.International students must fulfill the competency requirements forReading, Writing and Math with coursework accepted by TCC or withTHEA or ACCUPLACER testing.Have you met the competency requirements for Reading, Writing and Math asindicated in the information packet for this program? See the GeneralInformation Document and Entrance Requirements.Tarrant County College District is an Equal Opportunity institution that provides educational opportunities on the basis of merit and withoutdiscrimination because of race, color, religion, sex, age, national origin, veteran status, or disability.

Education:List the high school from which you received your diploma or enter GED/Home School, if applicable.Enter all Colleges/Universities attended and level of completion. You do not need to list non-accredited institutions.Check with Admissions or the Registrar's Office for information on accredited institutions.SchoolsLocationEntrance Semester& YearDeparting Semester& YearLevel ofCompletion:Name of SchoolCity/StateSemester Year Semester YearTotal SemesterHours or DegreeObtainedFailure to list all college-level institutions is grounds for dismissal from program, if selected. Failure to list all schoolsand provide required transcripts deems your application as incomplete.Repeated Coursework:List all courses that you have repeated/retaken to improve your GPA or to replace a low/failing grade. Failure to listrepeated classes on this application can adversely affect your final rating for program selection. It is yourresponsibility to list ANY and ALL repeated coursework below. We do not review transcripts to search for duplicatecoursework.It is not necessary for you to list classes from which you withdrew (usually designated with a "W").If necessary list coursework on an additional sheet of paper.CourseName and ID #Course InfoSchool, Semester, andYear course was takenGradeReceivedRepeatCourseName and ID #Repeat Course InfoSchool, Semester, and Yearcourse was re-takenGradeReceivedDo you have a Bachelor's Degree? Yes NoIf Yes, where was your Bachelor's Degree awarded?What was your major?Do you have observation experience in a physical therapy department or facility? _____Yes _____NoHave you worked as a PT Tech in a physical therapy department or facility? _____Yes _____No*If yes to either question please locate the "PTA Experience Form", and instructions for submission, withinthe PTA Information Booklet located at www.tccd.edu/pta.I attest that this application to the Physical Therapist Assistant Program is complete and correct. I understand thatby signing and submitting this application I am not guaranteed a place in this program and that I am only eligible forselection according to the terms listed in the information packet. I also understand that by signing the application Iam responsible for submitting ALL documents and information required for eligibility into this program to the AlliedHealth Department. I have read and understand the requirements and procedures for admission into the AlliedHealth programs as outlined in the Application Information Packet.10/10 Signature DateTarrant County College District is an Equal Opportunity institution that provides educational opportunities on the basis of merit and withoutdiscrimination because of race, color, religion, sex, age, national origin, veteran status, or disability.