DPT KNOXVILLE Supplemental Application

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DPT KNOXVILLE Supplemental Application

South College – Knoxville Campus
School of Physical Therapy

ATTN: DPT ADMISSIONS
400 Goody’s Lane, Suite 101
Knoxville, TN 37922

DEMOGRAPHIC INFORMATION

Name:

Title:

First:

Last:

Middle:

From among the following statements, please select all that apply to you.*

I graduated from a high school from which a low percentage of seniors receive a high school diploma.

I participated in an academic enrichment program in whole or in part by the Health Careers Opportunity Program, TRiO, or Upward Bound.

I am the first generation in my family to attend college (neither my mother nor my father attended college).

I applied or plan to apply for the PTCAS application fee waiver or assistance program.

I am fluent in 2 or more languages.

I am a licensed Physical Therapist Assistant.

I am a Certified Athletic Trainer.

I am currently serving, or previously served on active or reserve duty in the U.S. Military

Date or anticipated date of discharge

Type of discharge

None of these apply.

Are you a former or current student of South College?

Yes

If yes, what was your major or what courses did you take?

Have you previously applied for admission to the South College DPT program?

Yes

Which South College campus have you applied, to or intend to apply to, for admission to the DPT program? (Select all that apply)*

Atlanta

Dallas

Knoxville

Nashville

Orlando

Why did you choose the campus(es) from above?

If the campus of choice has reached capacity, are you open to attending a different South College DPT program location? The South College School of Physical Therapy has five locations with varying cohort start dates: Atlanta (June), Dallas (June), Knoxville (June and January), Nashville (September), Orlando (September)

Yes

Maybe

If Yes or Maybe, which campus(es)?

Are you currently employed by Confluent Health?

Yes

Unsure

Are you currently employed by an Evidence in Motion (EIM) Network Partner, Clinical Excellence Network (CEN) Participant, or Advanced Program Graduate.

Yes

Unsure

Did you review South College DPT social media accounts (Instagram, Facebook, LinkedIn) to gain more information on our program before applying?*

Yes, I have followed one or more of these accounts.

Yes, but only minimally

I did not access these accounts

DISCLOSURES AND RELEASE STATEMENTS

CAPTE Accreditation Status Disclosure:

The Doctor of Physical Therapy program at South College Knoxville is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria, Virginia 22314; telephone: 703-706-3245; email: accreditation@apta.org; website: www.capteonline.org.

I acknowledge that I have read and understand this statement regarding the program's Accreditation status.

Yes

Please contact Rose Williams at rwilliams@south.edu if you have questions or concerns regarding program accreditation status.

Blended Learning Acknowledgement:

The South College DPT program is a blended learning program. As such, the DPT curriculum is delivered using a combination of online distance-based, on-site lab intensive, and clinical education course components. This means that applicants should be technically proficient in basic internet use, have access to reliable internet, as well as able to travel to the on-site lab intensive sessions and clinical education experiences. By checking the box below, I acknowledge that I have read this statement, understand its implications, and agree to the aforementioned conditions.

Yes

FERPA Release

South College provides for the confidentiality of student records in accordance with the Family Educational Rights and Privacy Act (FERPA), as amended. I understand that in order to consider my application to any DPT program at any campus, the Office of Admissions will release my student records as necessary to members of the DPT Admissions Committee, employees of South College and others who have a need to access my student records in order to process my application for admission.

Yes

By entering your name, the last four digits of your social security number, and submitting the document, you electronically agree and confirm your understanding of the items, as outlined, in the above document as well as authorize the payment of the Supplemental Application fee to South College.

Supplemental Payment ($60.00):

Full Name:

Last four of social:

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