OHSU

Supplemental Application Form

OHSU PA Program Supplemental Application Online Form

OREGON HEALTH & SCIENCE UNIVERSITY
Physician Assistant Program
Supplemental Application for Admission

PLEASE PROVIDE THE FOLLOWING INFORMATION.

First Name:
MI:
Last Name:
CASPA ID #:
Email Address:
Have you previously applied for admission to the OHSU PA Program?   Yes   No
If yes, specify year(s):  Before 2005
 2005-2006
 2006-2007
 2007-2008
 2008-2009
 2009-2010

Section 1

The Admissions Committee fully recognizes the importance of diversity in its student body and in the physician assistant work force. Accordingly, the Physician Assistant Program strongly encourages applications from persons from all socioeconomic, racial, ethnic, religious, and educational backgrounds and persons from groups underrepresented in health care. To enable us to achieve this goal, we ask you to answer the following questions:

1)Describe the size of the principal city or town you lived in during childhood (< age 18).
2)Indicate the highest level of education achieved by your mother.
3)Indicate the highest level of education achieved by your father.
4)In high school or college, did you participate in a program to promote or enhance diversity in the health professions, science, or related careers such as the Health Careers Opportunity Program (HCOP), Minority Medical Education Program (MMEP), Summer Medical Education Program (SMEP), Trio, Gear Up, or Head Start?
Yes No
If yes, please describe program:


 

5) Please provide a brief summary of your foreign language skills. Information provided in this section is entirely optional and will not be used for admission decisions.

Language
Level of Most Recent Training
Total Years of Formal Training
Fluency

"Other":

"Other":

"Other":

"Other":

"Other":

"Other":

 

CRIMINAL BACKGROUND INFORMATION:

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?
Yes No
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?
Yes No
Do you currently have an arrest pending for a felony or misdemeanor?
Yes No
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

PREREQUISITE WORKSHEET

To be eligible for 2010 admissions, ALL PREREQUISITE COURSEWORK MUST BE COMPLETED ON OR BEFORE DECEMBER 31, 2010. A grade of 'C' or above is required to meet all prerequisites. 

Please enter the courses you deem appropriate to meet the prerequisites.

Bachelor's Degree required with completion by end of spring term 2011:
Degree: Major: Degree Date (Month-Year):

 

General or Cell Biology with Lab (full sequence - 2 semesters or 3 quarters)

Dept/Course #
Course Name
Credit
Hours
Grade
Term-Yr
Completed
or Planned
Institution

 

Inorganic Chemistry with Lab (full sequence - 2 semesters or 3 quarters)

Dept/Course #
Course Name
Credit
Hours
Grade
Term-Yr
Completed
or Planned
Institution

 

Microbiology with Lab or Bacteriology with Lab (one course with lab) (International grads must meet this requirement at a U.S. or Canadian institution.)

Dept/Course #
Course Name
Credit
Hours
Grade
Term-Yr
Completed
or Planned
Institution

 

Human Anatomy and Physiology wiht Lab (For 2011 admissions, transcripts must show courses successfully completed between 2004 and 2010; minimum of 2 semesters or 3 quarters of a combined A&P with lab or ONE semester each of anatomy with lab and physiology with lab) (International grads must meet this requirement at a U.S. or Canadian institution.)

Dept/Course #
Course Name
Credit
Hours
Grade
Term-Yr
Completed
or Planned
Institution

 

General or Developmental Psychology (one course)

Dept/Course #
Course Name
Credit
Hours
Grade
Term-Yr
Completed
or Planned
Institution

 

Statistics (one course; offered through statistics, math, psychology, or sociology departments)

Dept/Course #
Course Name
Credit
Hours
Grade
Term-Yr
Completed
or Planned
Institution

 


Section 3

SUPPLEMENTAL NARRATIVE

Instructions:

1. All first-time OHSU applicants: Please respond to the following (A, B, C, D) in concise typewritten statements. A 1-2 paragraph response per statement is sufficient.
2. Reapplicants to OHSU: Please respond to the "for reapplicants only" question (E).


  1. Describe your specific interest in the OHSU PA Program.



  2. 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?



  3. 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.



  4. 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?



 


  1. For reapplicants only: In planning for your reapplication this year, what specific aspects of last year's application did you feel could be improved upon? Provide updates, if any, to previous supplemental application answers (A-D). 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.



 


I certify that the information in this application is true and has been completed without evasion or misrepresentation. I understand and agree that providing false information on this application is just cause for my rejection or for my dismissal from the university if accepted.




Please review your information carefully. Once you are satisfied with your answers, be sure to click the Print Page button to print a copy of your application before you submit it below.

Your application will not be recorded unless you click the Submit Supplemental Application button below. An email confirming submission of your supplemental application will be sent to the email address you entered at the beginning of the form.