Physical Therapist Assistant Program Application …

1 Physical Therapist Assistant Program Application instructions All applicants must complete a current CCC Physical Therapist Assistant Program Application . The form should be completed with care as this Application represents you to the Physical Therapist Assistant Program Faculty. Prior applications will not be included in your current file. The Physical Therapist Assistant Program Application must be on file and complete in the office of Admissions and Records by June 1st to be considered for admission to the Physical Therapist Assistant Program for the Fall semester. For the Physical Therapist Assistant Program Application to be considered complete, the applicant must include the following: CCC Admission Application If not currently enrolled in CCC, complete anApplication for Admissions to Clovis Community College and return it to the Office Admissions and Records by June 1st.

2 Your Physical Therapist Assistant Program Application will not be processed if you do not have a current Application for Admission on file. Physical Therapist Assistant Program Application Complete all sections of the PhysicalTherapist Assistant Program Application , including the transcript information and observation hours log. Transcripts Official copies of high school and all college and university transcripts must besent directly to the Office of Admissions and Records and arrive prior to June 1st. If you are not a high school graduate, official GED scores are required. Send Official Transcript to: Clovis Community College, c/o Office of Admissions & Records, 417 Schepps Boulevard Clovis, New Mexico 88101.

3 Grade Point Average Applicants must have a minimum cumulative grade point average(GPA) of including all colleges and universities attended. Prerequisite Courses You must have completed all pre-requisite courses as detailed on the PTAdegree plan prior to enrollment in to the PTA Program . Applicants who are enrolled in the last of these prerequisites at the time of their Application may be considered but the courses must be noted as in progress with the anticipated completion date being prior to the Fall Semester. BIOL 211 (Human Anatomy and Physiology I), BIOL 212 (Human Anatomy and Physiology II),MATH 113 (Math for General Education), and NSG 105 (Medical Terminology) must have been completed within five years from semester of Application .

4 Observation Hours All applicants must complete at least 25 hours of observation with aPhysical Therapist or Physical Therapist Assistant and document completed hours on the Observational Hours Log Sheet found on the PTA webpage which must be submitted with the Application . Physical Therapist Assistant Program Application files, which do not contain all of the requirements listed above by June 1st, are considered incomplete . The incomplete applications will not be reviewed for acceptance by the Physical Therapist Assistant Program . The Application review process will ensure that the Program is blinded to student identifying information. Selection Procedure Applicants for the Physical Therapist Assistant Program will be selected based on the PTA Admissions Criteria Point System located on the CCC PTA Program Webpage.

5 Applicants who are ranked highest after the initial screening will be scheduled for the Health Occupation Entrance Test by the Allied Health Department. Following the test, rankings will be realigned and final selection will occur based on rank. Applicants are responsible for meeting with an Academic Advisor to file a current Physical Therapist Assistant degree plan and to review the information contained in the Clovis Community College Catalog. The policies and regulations contained in this catalog apply to all applicants, including those who have filed and are following degree plan requirements of an earlier catalog. Some policies and requirements may be subject to change based on Program requirements.

6 If you have any questions regarding the degree plan, contact the Academic Advising Center, located in the Dr. Miller Student Services Center, or call (575)-769-4020. Accreditation Statement: Graduation from a Physical Therapist Assistant education Program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria, VA 22314; phone; 703-706-3245; is necessary for eligibility to sit for the licensure examination, which is required in all states. The Physical Therapist Assistant Program at Clovis Community College is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria, Virginia 22314; telephone: 703-706-3245; email: website: NOTICE All of the Health Science programs at Clovis Community College require criminal background checks and drug screenings prior to admittance into the clinical setting.

7 Failure to pass one or both could result in dismissal from the Program . Applicants with felony convictions and certain misdemeanors may not be allowed in the clinical sites or allowed to sit for the National Physical Therapist Assistant Examination. TECHNICAL STANDARDS FOR ACCEPTANCE To participate in the clinical education portion of the Program , the applicant must possess additional non-academic skills. These technical standards are consistent with the duties of the entry level Physical Therapist Assistant in a professional position. The applicant must be able to: Lift and transfer patients to and from surfaces. Move, adjust, and manipulate equipment to perform procedures. Communicate effectively in an oral or written format, and follow written and verbal directions.

8 Use proper discretion and judgment in dealing with patients and others. Think clearly and rationally. Students cannot be in clinical practice while under influence ofprescribed medications which could affect decision making and ultimately jeopardize patientcare. Work harmoniously with others in a team while maintaining a high level of STATEMENT Any student who is seeking to transfer from another Physical Therapist Assistant Program will be considered with full Application procedure and leaving the previous Program in good academic and conduct standing. All students who are seeking to transfer from another Program will be expected to complete the CCC PTA Program in its entirety. Applicant InformationNote: If you change your address or telephone number, you must notify the Admissions and Records Department in a timely this your first Application to the Program : Yes_____ No_____If no, list the year of previous Application : _____Have you attended another college since your last Application .

9 Yes____ No____Where did you attend_____If yes, you must request an official copy of your transcript(s) to be mailed to the Office of Admissions and Records, or you may walk in an official, sealed Middle Last (Maiden)Date of Birth AddressCity/State/ZipPlease print legiblyPrimary PhoneSecondary Phone CCC Email (required)NamePhoneNamePhoneContact InformationEmergency Contacts SignatureApplicant's SignatureDateRevised January 2018C Male Female Home Cell Home CellFor important Application and transcript deadline information, please refer to the PTA Program insert. Please print legibly, fill out completely. List additional information on separate sheet if necessary. Physical Therapist Assistant Program Application 2018 Provisional AgreementI understand that my Application to the Physical Therapist Assistant Program at Clovis Community College is on a PROVISIONAL BASIS pending receipt of transcripts from the following school(s)/college(s) I agree to complete my Physical Therapist Assistant Application file no later than the published deadline.

10 (Deadlines are published on the insert contained in this packet) I understand that if my file is not complete by the published deadline it will not be forwarded to the Physical Therapist Assistant Selection CommitteeApplicant s Signature: Date:_____ I understand that all corrospondance regarding my Application , admission testing and acceptance into the Physical Therapist Assistant Program will be conducted through CCC email. Failure to check my CCC email may result in missed information or :Your record of paid employment is a consideration. Please describe work history by listing your most recent employment first. WorkHistory InformationPlace of Employment Dates of Employment Position Reason for Leaving Job Duties Place of Employment Dates of Employment Position Reason for Leaving Job Duties Correspondence Acknowledgement