Physical Therapist Assistant Program Application

*MANDATORY – Notifications will be made via email. Please ensure email address is correct.

Prior Education (list most recent first)

Employment Record (list most recent or present position)

Prerequisite Courses

Fill out the following with classes that have been previously taken. If currently enrolled, please write “E” for grade. Please note that if you have more than 1 course in progress, your application will not be considered.

Upload the Following

Please submit requested information only. Other documents submitted other than those requested will not be considered.

Recommendation Form  ** These must be hand delivered, mailed, or emailed by the person completing the form **

Hours of Observation Form

Observation Hours

Please fill out the following information AND submit the signed Hours of Observation form above.

Applicant Acknowledgement

This application will be used to complete the PTA Admissions Rubric. Final decisions on accumulated points will be determined by the PTA Admissions Committee.

I hereby certify that the information in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or falsification is cause for denial of admission or expulsion from the college. I understand that the faculty and staff of the San Jacinto College South- Physical Therapist Assistant Program will read the information contained in this application.

Please ensure complete accuracy on form submission as no changes can be made after submission.