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Dear Applicant: Thank you for your interest in the Physician ... Dear Applicant: Thank you for your interest in the Physician ... Document Transcript

  • College of Health Professions Clinical Services Physician Assistant Program 151 B Rutledge Avenue PO BOX 250962 Charleston • SC 29425 Ph (843) 792-3775 FAX: (843) 792-0506 Dear Applicant: Thank you for your interest in the Physician Assistant Program here at the Medical University of South Carolina. Our program is housed in the College of Health Professions along with a variety of other health professional programs. Our students benefit from interdisciplinary training and opportunities to develop relationships with a large, diverse group of future healthcare colleagues. You have chosen an excellent program and a strong profession. Physician Assistants contribute significantly to healthcare delivery for many South Carolinians and patients all across the country. The profession was recently ranked as the #1 fastest growing profession by Money Magazine™. Our program earned approval in 2003 for an entry-level Masters of Science degree in Physician Assistant Studies by the Medical University of South Carolina and the South Carolina Commission on Higher Education. The program is fully accredited by the Accreditation Review Commission on Education for the Physician Assistants (ARC-PA). MUSC confers a Master of Science in Physician Assistant Studies (MSPAS) upon completion of the program. We strive to prepare compassionate, diverse graduates to collaborate with physicians to provide high quality healthcare to all patients. Our innovative training program focuses on primary care and evidence-based medicine and is supported by the most current medical and information technology. We are proud to see our graduates become life-long learners who seek opportunities to advance our profession. On behalf of the faculty, staff, and current students, I assure you that your application will be reviewed with utmost care. If you have any questions or concerns about our admissions process or the program, please do not hesitate to contact us at 843-792-3775. Sincerely, Paul F. Jacques, DHSc, MEd, PA-C Association Professor and Interim Director “An equal opportunity employer, http://www.musc.edu promoting workplace diversity.” HP PA Supplement 06/10
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 1. OFFICIAL TRANSCRIPT(S) • Official transcripts from EACH post-secondary institution you have attended are required by most programs. • Use the “Transcript Request Form” or send your own request to the registrar of each institution you have attended. Be sure the registrar follows the instructions printed on the Request Form. DO NOT OPEN THE ENVELOPE that contains the document. If the registrar will not give you an official copy, explain this in a note to MUSC’s Enrollment Management office and have the transcript(s) sent under separate cover. • Final transcripts showing completion of work-in-progress and/or degree awarded must ALSO be sent to Enrollment Management and must be received no later than the end of the first semester of your enrollment. Failure to do so may result in your disenrollment at MUSC. • Electronic transcripts are welcomed by MUSC. If your prior college registrar can send transcripts electronically through the national services at the University of Texas, Austin, please request your prior college to direct documents to MUSC’s Office of Enrollment Management. 2. OFFICIAL TEST SCORE RESULTS • Applicants are responsible for taking the entrance test(s) required by their program and for having the scores sent directly to MUSC’s Enrollment Management office. • Test score results must be sent directly by the testing service. Photocopies of score reports are not acceptable. Scores reported on transcripts are not acceptable, with the exception of SAT scores, which can be obtained from official high school transcripts. • Arrange to take the test your program requires and provide your testing agency with the proper test code for the Medical University: 5407 • Test information and a registration form can be obtained by contacting the agency as follows: GRE: code R5407 (no department code) TOEFL: (code R5407) Graduate Record Examination TOEFL/TSE Services (609) 771-7670 (609) 771-7100 http://www.gre.org http://www.ets.org/toefl • Test agencies usually take four to six weeks to report your scores. 3. APPRAISALS/REFERENCE FORMS • You are responsible for contacting your appraisers. • Confidential Appraisal/Reference Forms are sent electronically. Type the names and email address of the appraisers on the forms. Type your own name, and indicate if you waive your rights. Request the appraiser to read carefully the instructions for preparation printed at the bottom of the form. DO NOT OPEN THE ENVELOPE containing the appraisal. • Appraisals are usually provided by major advisors, professors, or employers but must include at least one recommendation from a licensed health care professional. These people have busy schedules; contact them EARLY.
  • 4. COURSE LISTING • One or both of these forms must be completed, depending on your program, and included in your supplemental mailing: a) ALL programs: Plans for Remaining Academic Year (course-in-progress and/or future enrollment) b) SOME programs: Prerequisite Course Requirements 5. LICENSE • Include a copy of your license if you hold a health professions license. 6. PATIENT CARE EXPERIENCE LOG 7. DEMOGRAPHIC PROFILE SHEET ADDITIONAL ADVISORY INFORMATION FOR APPLICANTS: VETERAN EDUCATIONAL BENEFITS • Contact the Veteran’s Coordinator at (843) 792-1639. MILITARY PERSONNEL or DEPENDENTS OF MILITARY • Include a copy of your military orders and the Petition for Residency if you are seeking in-state residency classification. INFORMATION UPDATES • Notify Enrollment Management immediately of any change to: a) preferred mailing address b) email address c) legal name d) telephone number e) courses-in-progress f ) courses-to-be-taken While the applicant may contact department offices and faculty, he/she should know that offers of admission originate only in the office of the Dean of the college in a formal letter signed by the Dean. The applicant is advised to keep copies of all material sent to the University. All original application materials submitted to the University become the property of the University and cannot be returned to an applicant, cannot be copied for an applicant, and cannot be forwarded to any other institution on behalf of the applicant. The Office of Enrollment Management is available 8:00 a.m. to 4:30 p.m. Monday through Friday. Program admission special- ists are generally available to answer questions. An applicant may telephone the office at (843) 792-5396, may write to Enrollment Management in care of The Medical University of South Carolina at 41 Bee Street, MSC 203 in Charleston, SC 29425-2030, or send email to oesadmis@musc.edu. Forms in this packet should be completed and mailed to: Office of Enrollment Management Medical University of South Carolina 41 Bee Street MSC 203 Charleston, SC 29425-2030
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 Reference Form College of Health Professions • College of Nursing Please use black ink Name of Applicant ___________________________ SSN or, PVID, or CollegeNet ID:______________ (Please type or print) Permanent Address ____________________________________________________________________ Program or Department of Interest ____________________________________ Please have this form completed by a current or former instructor, advisor, or supervisor who is in a position to evaluate your potential. Some individuals prefer not to complete reference forms unless they can be assured of the confidentiality of their comments. It is our Applicant opinion that comments provided on a confidential basis are likely to be of more help to us in judging important characteristics such as creativity, originality, independence, and research capability. Therefore, the University is affording you the opportunity to waive your right of subsequent access to this reference statement. Regardless of your decision on waiving your right of future review, your application for admission will be given full consideration. I do ❏ do not ❏ waive my right of subsequent access to this recommendation form. ____________________________________________________________________________________________________ Date Signature of Applicant Name of Evaluator ____________________________________________________________________________________ Evaluator (Please type or print) As required by the Family Educational Rights and Privacy Act, a student may elect to waive the subsequent access to this recommendation form. In either case, the admissions committee would appreciate your opinion concerning the applicant named above. I have known the applicant for __________ years in my capacity as ______________________________________ _______________________________________________________________________________________ Do you have any reason to doubt this applicant’s integrity? ❏ Yes ❏ No If yes, please explain separately. How would you rate this student (on a scale of 1 to 10, with 10 the highest) compared to other students at the same educational level with regard to: (Please expand wherever possible. Use “N.O.” for Not Observed.) Previous accomplishments Intellectual independence Capacity for analytical thinking Ability to organize and express ideas clearly orally Ability to organize and express ideas clearly in writing Drive and motivation Perseverance Emotional stability Research aptitude Ability to work with others
  • Name of Applicant ___________________________ SSN or, PVID, or CollegeNet ID:______________ (Please type or print) What do you feel are the applicant’s: strongest points? ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ weakest points? _________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ How would you rank this student compared to other students at the same educational level with regard to the probability of successful handling of advanced course work?______________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Please make other comments that you feel will help us evaluate the applicant. _____________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ recommend the applicant as follows: Highest Strong Recommend Recommend with Recommend with Do not Recommendation Recommendation Few Reservations Reservations Recommend For admission to an undergraduate program For admission to a masters program For admission to a doctoral program _________________________________________________________________________________________________ Signature Date _________________________________________________________________________________________________ Name and Title (typed or printed) Telephone Number _________________________________________________________________________________________________ Address City/State/Zip __________________________________________________________ USC Alumni? _________________________ M E-mail Address Please attach any other evaluative documents to this appraisal, place in a sealed envelope, sign across the seal, and return to the applicant or mail directly to the Office of Enrollment Management at the address listed at the top of this form. If applicant requests that you fax this information in addition to returning the sealed original, please fax the information to the Office of Enrollment Management at (843) 792-6615. The Medical University of South Carolina does not discriminate on the basis of race, creed, national origin, sex, age, or disability in the recruitment and admission of students, employment of faculty and staff, and the operation of other educational activities and programs as specified by federal laws and regulations.
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 Reference Form College of Health Professions • College of Nursing Please use black ink Name of Applicant ___________________________ SSN or, PVID, or CollegeNet ID:______________ (Please type or print) Permanent Address ____________________________________________________________________ Program or Department of Interest ____________________________________ Please have this form completed by a current or former instructor, advisor, or supervisor who is in a position to evaluate your potential. Some individuals prefer not to complete reference forms unless they can be assured of the confidentiality of their comments. It is our Applicant opinion that comments provided on a confidential basis are likely to be of more help to us in judging important characteristics such as creativity, originality, independence, and research capability. Therefore, the University is affording you the opportunity to waive your right of subsequent access to this reference statement. Regardless of your decision on waiving your right of future review, your application for admission will be given full consideration. I do ❏ do not ❏ waive my right of subsequent access to this recommendation form. ____________________________________________________________________________________________________ Date Signature of Applicant Name of Evaluator ____________________________________________________________________________________ (Please type or print) Evaluator As required by the Family Educational Rights and Privacy Act, a student may elect to waive the subsequent access to this recommendation form. In either case, the admissions committee would appreciate your opinion concerning the applicant named above. I have known the applicant for __________ years in my capacity as ______________________________________ _______________________________________________________________________________________ Do you have any reason to doubt this applicant’s integrity? ❏ Yes ❏ No If yes, please explain separately. How would you rate this student (on a scale of 1 to 10, with 10 the highest) compared to other students at the same educational level with regard to: (Please expand wherever possible. Use “N.O.” for Not Observed.) Previous accomplishments Intellectual independence Capacity for analytical thinking Ability to organize and express ideas clearly orally Ability to organize and express ideas clearly in writing Drive and motivation Perseverance Emotional stability Research aptitude Ability to work with others
  • Name of Applicant ___________________________ SSN or, PVID, or CollegeNet ID:______________ (Please type or print) What do you feel are the applicant’s: strongest points? ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ weakest points? _________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ How would you rank this student compared to other students at the same educational level with regard to the probability of successful handling of advanced course work?______________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Please make other comments that you feel will help us evaluate the applicant. _____________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ recommend the applicant as follows: Highest Strong Recommend Recommend with Recommend with Do not Recommendation Recommendation Few Reservations Reservations Recommend For admission to an undergraduate program For admission to a masters program For admission to a doctoral program _________________________________________________________________________________________________ Signature Date _________________________________________________________________________________________________ Name and Title (typed or printed) Telephone Number _________________________________________________________________________________________________ Address City/State/Zip __________________________________________________________ USC Alumni? _________________________ M E-mail Address Please attach any other evaluative documents to this appraisal, place in a sealed envelope, sign across the seal, and return to the applicant or mail directly to the Office of Enrollment Management at the address listed at the top of this form. If applicant requests that you fax this information in addition to returning the sealed original, please fax the information to the Office of Enrollment Management at (843) 792-6615. The Medical University of South Carolina does not discriminate on the basis of race, creed, national origin, sex, age, or disability in the recruitment and admission of students, employment of faculty and staff, and the operation of other educational activities and programs as specified by federal laws and regulations.
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 Reference Form College of Health Professions • College of Nursing Please use black ink Name of Applicant ___________________________ SSN or, PVID, or CollegeNet ID:______________ (Please type or print) Permanent Address ____________________________________________________________________ Program or Department of Interest ____________________________________ Please have this form completed by a current or former instructor, advisor, or supervisor who is in a position to evaluate your potential. Some individuals prefer not to complete reference forms unless they can be assured of the confidentiality of their comments. It is our Applicant opinion that comments provided on a confidential basis are likely to be of more help to us in judging important characteristics such as creativity, originality, independence, and research capability. Therefore, the University is affording you the opportunity to waive your right of subsequent access to this reference statement. Regardless of your decision on waiving your right of future review, your application for admission will be given full consideration. I do ❏ do not ❏ waive my right of subsequent access to this recommendation form. ____________________________________________________________________________________________________ Date Signature of Applicant Name of Evaluator ____________________________________________________________________________________ (Please type or print) Evaluator As required by the Family Educational Rights and Privacy Act, a student may elect to waive the subsequent access to this recommendation form. In either case, the admissions committee would appreciate your opinion concerning the applicant named above. I have known the applicant for __________ years in my capacity as ______________________________________ _______________________________________________________________________________________ Do you have any reason to doubt this applicant’s integrity? ❏ Yes ❏ No If yes, please explain separately. How would you rate this student (on a scale of 1 to 10, with 10 the highest) compared to other students at the same educational level with regard to: (Please expand wherever possible. Use “N.O.” for Not Observed.) Previous accomplishments Intellectual independence Capacity for analytical thinking Ability to organize and express ideas clearly orally Ability to organize and express ideas clearly in writing Drive and motivation Perseverance Emotional stability Research aptitude Ability to work with others
  • Name of Applicant ___________________________ SSN or, PVID, or CollegeNet ID:______________ (Please type or print) What do you feel are the applicant’s: strongest points? ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ weakest points? _________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ How would you rank this student compared to other students at the same educational level with regard to the probability of successful handling of advanced course work?______________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Please make other comments that you feel will help us evaluate the applicant. _____________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ recommend the applicant as follows: Highest Strong Recommend Recommend with Recommend with Do not Recommendation Recommendation Few Reservations Reservations Recommend For admission to an undergraduate program For admission to a masters program For admission to a doctoral program _________________________________________________________________________________________________ Signature Date _________________________________________________________________________________________________ Name and Title (typed or printed) Telephone Number _________________________________________________________________________________________________ Address City/State/Zip __________________________________________________________ USC Alumni? _________________________ M E-mail Address Please attach any other evaluative documents to this appraisal, place in a sealed envelope, sign across the seal, and return to the applicant or mail directly to the Office of Enrollment Management at the address listed at the top of this form. If applicant requests that you fax this information in addition to returning the sealed original, please fax the information to the Office of Enrollment Management at (843) 792-6615. The Medical University of South Carolina does not discriminate on the basis of race, creed, national origin, sex, age, or disability in the recruitment and admission of students, employment of faculty and staff, and the operation of other educational activities and programs as specified by federal laws and regulations.
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 Prerequisite Course Requirements College of Health Professions Master of Science in Physician Assistant Studies Applicant Name: _____________________________________________ SSN or, PVID, or CollegeNet ID: ____________________ (Please use black ink • Please print) Term of Entrance: ■ Summer 20 ______ please ✓ or complete as applicable: HOURS DATE NOW IN TERM/YR COURSES COURSE # EARNEDΔ COLLEGE EARNED PROGRESS or PLANNED COLLEGE OF HEALTH PROFESSIONS – PHYSICIAN ASSISTANT STUDIES English composition or Literature (6) __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ Mathematics (3) – college algebra or above __________ ________ __________ ________ ___________ _________ Statistics (3) - required __________ ________ __________ ________ ___________ _________ Biology – must include lab (4) __________ ________ __________ ________ ___________ _________ Microbiology – must include lab (4) __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ Anatomy – must include lab (4)* __________ ________ __________ ________ ___________ _________ Physiology – must include lab (4)* __________ ________ __________ ________ ___________ _________ Organic/Biochemistry (3) __________ ________ __________ ________ ___________ _________ General Chemistry – must include lab (8) __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ General Psychology (3) __________ ________ __________ ________ ___________ _________ Behavioral sciences (6) __________ ________ __________ ________ ___________ _________ anthropology, sociology, psychology __________ ________ __________ ________ ___________ _________ Humanities (12) __________ ________ __________ ________ ___________ _________ Choose from at least two: education, fine arts, __________ ________ __________ ________ ___________ _________ speech, foreign language, literature, philosophy, economics, history, political science __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ Electives** (30) __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ Electives continued on page 2 __________ ________ __________ ________ ___________ _________ Required number of semester hours in parentheses . List only courses completed with a grade of "C" (2.0) or above. Survey courses are not acceptable to satisfy science requirements. * Combined Anatomy and Physiology courses are accepted; however, you MUST take Anatomy and Physiology I and II to fulfill the separate Anatomy and Physiology requirements. ** Recommended electives include courses in communications, computer science, epidemiology, and medical terminology. Course must be liberal arts/sciences and not professional or technical in nature. Δ Semester hours (convert quarter hours, if necessary – 1.5 qtr. hr.=1 sem. hr.) (more)
  • Applicant Name: _____________________________________________ SSN or, PVID, or CollegeNet ID: ____________________ Electives** (continued) __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ _________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ __________ ________ __________ ________ ___________ _________ Information about the transfer course articulation among South Carolina colleges and universities may be found at http://www2.musc.edu/ ES/transfer_policy/transfer_index.html In concert with current policies and procedures, candidates will be chosen on the basis of (1) prior academic work, (2) GRE scores, (3) recommendations. Subsequent class selection preference will be given to interviewees with direct “hands on” patient care experience. All participants selected for admission must have completed at least 1 interview. ** Recommended electives include courses in communications, computer science, epidemiology, and medical terminology. Course must be liberal arts/sciences and not professional or technical in nature.
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 Plans for Remaining Academic Year Please PRINT in black ink for all information below: Name ____________________________________________ SSN or, PVID, or CollegeNet ID: _____________________ Program __________________________________________ For pre-admission counseling and to evaluate your qualifications for admission, please list courses in which you are presently enrolled (in progress) and courses you plan to complete prior to entering the Medical University of South Carolina. Transcripts of any work, planned or in progress, must be sent as soon as completed. Official final transcripts of all college work completed must be received prior to the end of your first semester of enrollment at MUSC. If you have completed all coursework, please write N/A at the top of this form. Courses in Progress: College/University __________________________________________ Semester/Quarter & Year _____________________________ COURSE TITLE CREDIT HOURS (S/Q) ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Courses Planned to be Completed Prior to Entry: College/University __________________________________________ Semester/Quarter & Year _____________________________ COURSE TITLE CREDIT HOURS (S/Q) ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ College/University __________________________________________ Semester/Quarter & Year _____________________________ COURSE TITLE CREDIT HOURS (S/Q) ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ _______________________________________________________ _________________________________________________ Applicant’s Signature Date _______________________________________________________ _________________________________________________ Applicant’s Address City/State/Zip Attach another sheet if additional space is needed.
  • ____ Check here if you have no health care related experience Physician Assistant Program LOG OF HEALTH CARE RELATED EXPERIENCE* Name: _________________________________________________ SSN or, PVID, or CollegeNet ID: _______________________ please print or type in black Category of Supervisor Total Experience Clinic / Hospital Description of Work Dates of Service Supervisor Contact Number Name Performed Name (Paid or Volunteer) Begin Date End Date Information of Hours Reviewed by: ____________________________ Date: _______________ To be completed by OEM (internally) Total Hours This Page Hours from Previous Pages *Health related experience is not required in order to be eligible for acceptance into Total Hours this program. Patient care experience does, however, add value to your application. Page ____________ of _______________ If you accrue additional experience between the application period and an interview date, please notify the event coordinator prior to your first interview.
  • Medical University of South Carolina Physician Assistant Demographic Profile Name: _________________________________________________ SSN or, PVID, or CollegeNet ID: _______________________ please print or type in black The following questions are asked to help us understand how your background may fulfill the MUSC Physician Assistant Mission Statement. Please mail this form to Office of Enrollment Management, Medical University of South Carolina, 41 Bee Street, MSC 203, Charleston, SC 29425-0203 1. How would you best describe your home town? ■ Rural (outside of city limits - population less than 9,999) ■ Small town (population between 10,000 and 24,999) ■ Suburban (population between 25,000 and 49,999) ■ Metropolitan (population 50,000 and over) ■ Inner city (neighborhood consists of more than 50% lower income housing) ■ Inner city (neighborhood was medically undeserved) 2. Are you the first person in your family to have attended college? ■ Yes ■ No 3. In formative years (first 12 years of life), did you come from a single-parent household? ■ Yes ■ No 4. In formative years (first 12 years of life), did your family live in? ■ Subsidized housing ■ Rented house ■ Owned home 5. Was a language other than English spoken in your home? ■ Yes ■ No Are you fluent in a language other than English? ■ Yes ■ No 6. In what area of the country do you hope to pursue your career? ■ Rural South Carolina ■ Anywhere in South Carolina ■ Southeastern U.S. ■ Wherever there is a demand ■ Outside the U.S. ■ Not sure yet 7. How much of your annual undergraduate college expenses did you earn? (not including scholarships and/or student loans) ■ 25% or less ■ 51% to 75% ■ 26% to 50% ■ 76% or greater 8. Family Income while growing up (total income of all members living at home): ■ $25,000 or less ■ $75,000 to $99,999 ■ $25,001 to $49,999 ■ $100,000 or greater ■ $50,000 to $74,999 9. How many people lived in your home? __________________ 10. Are you a veteran of the United States uniformed services? ■ Yes ■ No Signature :__________________________________________________ Date:____________________
  • Office of Enrollment Management 41 Bee Street MSC 203 Charleston SC 29425-2030 University Minimum Abilities for Eligibility to Participate Successfully in Educational Programs and Activities The following abilities are needed by all students in the university. While admission decisions do not take disabilities into consideration, nor are applicants invited to disclose a disability, all persons interested in entering a health profession education program should be aware of minimum abilities required for success. • Ability to make proper assessments and lawful judgments regarding health care. • Ability to prioritize and carry out interventions. • Ability to adapt to a variety of patient/client situations, including crises. • Ability to communicate effectively. • Ability to obtain, interpret, and document data. • Ability to measure outcomes of patient care. • Ability to participate in discussion in the classroom, in the clinical arena, and with colleagues/patients/clients/the public. • Ability to acquire information developed through classroom instruction, clinical experiences, independent learning, and consultation. • Ability to complete reading assignments and to search and evaluate literature. • Ability to complete written assignments and maintain written records. • Ability to solve problems. • Ability to perform duties while under stress. • Ability to meet deadlines, to manage time. • Ability to complete computer-based assignments, and use the computer for searching, recording, storing, and re- trieving information. • Ability to complete assessment examinations. These abilities may be accomplished through direct student response, through use of prosthetic devices, or through personal assistance (e.g. readers, signers, notetakers, etc.). The responsibility for the purchase of prosthetic devices serving a student in meeting the above required abilities remains with the student and/or the agency supporting the student. The university will assist with providing notetakers, readers, signers, and other attending services. Upon admission, a student who discloses a disability (with certification) is assured of reasonable accommodation. These accommodations include: opportunities for individual and group counseling; peer counseling; linkages with community services; faculty advisory committees that are aware of disabled students and their needs; career counsel- ing; assistance with job searches and interview skills; and, of course, the more familiar accommodations of extended test-taking time, and other enabling services. Students seeking accommodation initiate their request in the office of the dean of the college in which they have matriculated.
  • Program Minimum Skills for Eligibility to Participate in Educational Programs and Activities The following skills are needed by applicants to this program. Applicants and students should possess these abilities, or with the help of compensatory techniques and/or assistive devices, be able to demonstrate ability to become proficient. Manual dexterity: Ability to use therapeutic communication: • wrists (both) • hands (both) • attending • clarifying • fingers (all) • arms (both) • coaching • facilitating • grasping • fingering • touching • reading • pinching • pushing • writing • pulling • holding • extending • twisting (rotating) Intellectual ability to accomplish: • cutting • measurements • calculations • reasoning • analysis Sensation: • synthesis • problem solving • palpation • ausculation • percussion Ability to be assertive Visual perception: Ability to delegate • depth • color Ability to function (consult, negotiate, share) • acuity (corrected to 20/40) as part of a team Ability to participate in role-playing activities Physical strength: • to support another person Ability to display and maintain mental and emotional • to position another person stability • to transfer to/ambulate with walker, cane, crutches, bed, chair Other: • provide motion exercises To be poised and self-confident • to stand for long periods of time To be able to read, write, understand and • to perform CPR; resuscitation communicate proficiently and effectively in the English language Ability to use sterile techniques and universal To be able to remain calm during emergency precautions situations To be able to meet and deal with people of differing Ability to operate and maintain equipment backgrounds and behavioral patterns (e.g., ventilator, electronic monitor, etc.) To display and maintain mental and emotional stability Ability to measure: To be free from any active diseases that are infectious • body (height, weight, range, strength, etc.) and may be spread by routine means, such as • vital signs handshakes, skin contact and breathing. • intake and output • outcomes, results (e.g. lab tests) NOTE: Students seeking to request reasonable • psychological status (general) accommodation may do so by filing a • using a variety of monitoring modalities "Disability Accommodation Request" form in the Student Services Center, College of Health Professions.