PA Supplemental Application: ASHEVILLE 2024 - 2025 CASPA Cycle

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PA Supplemental Application for Asheville Campus

Please send all transcripts directly to CASPA. GRE scores are sent directly to South College (code:5009).

In order to officially apply to the program, please complete your application with CASPA at : http://www.caspaonline.org

You must have a CASPA ID prior to completing this Supplemental Application.

The ARC-PA has granted Accreditation-Provisional status to the South College Asheville Physician Assistant Program sponsored by South College.

Accreditation-Provisional is an accreditation status granted when the plans and resource allocation, if fully implemented as planned, of a proposed program that has not yet enrolled students appear to demonstrate the program’s ability to meet the ARC-PA Standards or when a program holding Accreditation- Provisional status appears to demonstrate continued progress in complying with the Standards as it prepares for the graduation of the first class (cohort) of students.

Accreditation-Provisional does not ensure any subsequent accreditation status. It is limited to no more than five years from matriculation of the first class.

The program’s accreditation history can be viewed on the ARC-PA website at http://www.arc-pa.org/accreditation-history-south-college-asheville/.

Caspa ID:

Name:

Title:

First:

Last:

Middle:

Under what other name(s) might documents be received?

Age:*

Date of Birth:*

Place of Birth:*

Race:*

Social Security Number:*

Sex:*

*INFORMATION NEEDED FOR STATISTICAL REPORTING TO THE U.S. DEPT. OF EDUCATION.

Telephone number at which you can be reached between 8:00am and 5:00pm:

Home Phone:

Cell Phone:

E-mail:

Permanent Address:

Street Address:

City:

State / Province / Region:

Postal/ Zip Code:

Country:

Temporary Address:

Street Address:

City:

State / Province / Region:

Postal/ Zip Code:

Country:

Preferred mailing address:

Permanent

Temporary

County and state of legal residence:

County:

State:

Employed by:

Occupation:

Business Phone:

Emergency Contact Name:

First:

Last:

Relationship:

Emergency Contact Address:

Street Address:

City:

State / Province / Region:

Postal/ Zip Code:

Country:

Emergency Contact Phone:

Are you a United States Citizen?

Yes

Have you previously applied for admission to South College?

Yes

How did you learn about the Physician Assistant Program?

EDUCATION

Undergraduate Degree (List all cities, states with dates of schools and universities attended)

#1 College

Name:

Address:

City:

State / Province / Region:

Postal/ Zip Code:

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Date of degree (if any):

Dates of attendance:

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#2 College

Name:

Address:

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Add Another College

#3 College

Name:

Address:

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Date of degree (if any):

Dates of attendance:

Year of graduation:

Major:

Minor:

Graduate Degree (if applicable)

#4 College

Name:

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Date of degree (if any):

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Add Another College

#5 College

Name:

Address:

City:

State / Province / Region:

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Date of degree (if any):

Dates of attendance:

Year graduate degree earned:

Major (graduate):

Prerequisite Courses

Have you completed all prerequisite courses (as listed on the SCPA website)?

Yes

GRE Test Information

Have you taken the GRE?

Yes

Additional Questions

DO YOU WISH TO APPLY FOR FINANCIAL AID?

Yes

Are you a first-generation college student?

Yes

Would you characterize yourself as coming from a disadvantaged socioeconomic background?

Yes

Would you characterize yourself as coming from a geographically medically underserved area?

Yes

Are you bilingual?

Yes

Do you have any significant extraordinary life and/or healthcare experiences?

Yes

Are you a Veteran with military health care experience?

Yes

Medical Military Experience

Branch of military:

Number of years of active duty:

Date of entrance: (mm/yyyy)

Date of discharge: (mm/yyyy)

Type of discharge:

If you are now on active duty, what is the earliest date you would be available to enter the program? (mm/yyyy):

Were/are you a corpsman or medic in the service?

Yes

IDC:

Yes

18-D:

Yes

Will you be attending under the GI Bill?

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 the School of Physician Assistant Studies, the Office of Admissions will release my student records as necessary to members of the School of Physician Assistant 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.

RELEASE

I hereby release South College and any firm with which South College may contract, from any debts, claims, actions, causes of action, demands, suits, and all liabilities whatsoever both in law and in equity, which may result from participation in any telecast or still photography made by or produced by South College.

In doing so, I hereby grant South College the right to use my name, photograph, likeness, or voice in any production connected with the College.

I hereby represent and warrant that I am of full age and have every right to contract in my own name in the above regard. I further state that I have read the above authorization and release prior to its execution and that I am fully familiar with the contents thereof.

I certify that all statements made in this supplemental application are complete and true and understand that every student enrolling at South College agrees to abide by all policies and regulations of the College that may be found in the Student Handbook or in the College Catalog or other official publication. I understand and agree that any misrepresentation of facts on this supplemental application is just cause for refusal of admission or dismissal from South College.

As acceptance of this registration, please type your full name below.

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 ($95.00):

Full Name:

Last four of social:

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