Supplemental Application Form

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:

Urban Environment (>1,000,000 population) Large City (100,000 to 1,000,000 population) Mid-size city (50,000 to 99,999 population) Large Town (10,000 to 49,999 population) Small Town (2,500 to 9,999 population) Isolated Rural (<2,500 population)

Primary School High School Graduate College Graduate Master's Degree Doctoral Degree Unknown

Primary School High School Graduate College Graduate Master's Degree Doctoral Degree Unknown

Yes No

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.

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.

Yes No

Yes No

Yes No

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.

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?
   
   
   
   

5. 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.