Pace University – Lenox Hill Hospital

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Pace University – Lenox Hill Hospital

  1. 1. Pace University – Lenox Hill Hospital Physician Assistant Program Supplemental Application Thank you for your interest in the Pace University-Lenox Hill Hospital Physician Assistant Program. Students who successfully complete the program will receive a B.S. Degree from Pace University and a Certificate of Completion from Lenox Hill Hospital. FRESHMAN STUDENTS should submit an Application for Undergraduate Admission and a Supplemental PA Program Application. Please note that the PA personal statement and recommendation form will satisfy essay/recommendation requirements for both applications. Priority deadline for Fall 2005 is December 1, 2004. Mail both your applications (may use enclosed envelope) to: Pace University Application Processing Center 861 Bedford Road Pleasantville, NY 10570-2799 The Pace University- Lenox Hill Hospital PA Program operates on a rolling admission basis. Therefore, students who apply early have a better chance of successfully securing a seat in the class. Please review the Physician Assistant Program brochure for specific admission related information. If you have questions or need additional information please contact the PA Program office at (212) 346-1357. The Office of Undergraduate Admission, (212) 346- 1323/1225 will be happy to answer any questions you might have regarding the application process. THE CHECKLIST BELOW WILL ASSIST YOU IN COMPLETING THE APPLICATION PROCESS Pace University Applications PA Program Supplemental Application  Completed Application  Health Care Experience Form  Application Fee  3 Completed Recommendations  High School/College Transcripts (arrange for official  Completed Personal Statement transcripts sent to Application Processing Center) Once your file is complete, the Admissions Committee and the Physician Assistant Program will review it. If you meet the criteria, an interview may be scheduled. Interviews will be conducted starting January 2005.
  2. 2. Pace University – Lenox Hill Hospital Physician Assistant Program Recommendation Form To the Applicant: (Please remember that you need 3 recommendations for a completed application.) Print Name: _____________________________________________________________ Social Security Number ________________________ Phone _____________________ I waive access to this evaluation. I do not waive access to this evaluation. To the Evaluator: If the applicant has not checked one of the boxes above, it will be assumed that she/he wishes to have access to this evaluation. In what capacity do you know the student? ____________________________________ For how long have you known the applicant? ___________________________________ Please evaluate the applicant based on you actual observations. Check the number, which most closely reflects his or her performance, with 5 being the best score and 1 being the lowest or most unfavorable score. Motivation: The level of incentive demonstrated by the applicant as it applies to assignments and other responsibility. 5 4 3 2 1 Not observed Leadership: The ability of the applicant to present him/herself in a authoritative and influential manner with others. 5 4 3 2 1 Not observed Sensitivity: Applicant’s awareness of attitudes and feeling of others and his or her ability to be discreet. 5 4 3 2 1 Not observed Responsibility: Reliability and accountability for his/her own actions and obligations. 5 4 3 2 1 Not observed Integrity: Honesty and straightforwardness in dealing with others. 5 4 3 2 1 Not observed Flexibility: Ability to adjust well to unexpected change. 5 4 3 2 1 Not observed
  3. 3. Maturity: Ability of the applicant to handle academic and personal issues in a mature, responsible manner. 5 4 3 2 1 Not observed Appearance: Dress, hairstyle, neatness, etc. appropriate to the work or school setting. 5 4 3 2 1 Not observed Interpersonal Skills: Ability to relate appropriately to peers and those in authority. 5 4 3 2 1 Not observed Attendance: Ability to be at designated functions as scheduled and on time. 5 4 3 2 1 Not observed Judgment: Ability to arrive at an appropriate conclusion by carefully weighing, discerning and comparing evidence and testing premises. 5 4 3 2 1 Not observed Relating to peers: Ability of applicant to interact with patients in a professional and compassionate manner. 5 4 3 2 1 Not observed Because of the rigorous academic demands and significant patient care responsibilities give to physician assistants, the applicant must be of above average intellect, mature, disciplined, able to accept criticism and highly motivated to succeed. With this in mind, how would you rate this applicant? Outstanding Above average Average Below average Comments: (Please print) Evaluator’s name: ___________________________________ Title: __________ Address: __________________________________________________________ Signature: _________________________________________________________ Do not return this evaluation to the applicant. Mail this form to: Pace University Application Processing Center 861 Bedford Road Pleasantville, NY 10570-2799
  4. 4. Pace University – Lenox Hill Hospital Physician Assistant Program Personal Statement Form Please complete this statement. We would like to know why you wish to become a Physician Assistant and what qualities and strong points you have that make you a good applicant for this program. We would also like to know why you chose our program. (You may attach additional pages if necessary). Name: ___________________________________ Telephone:_____________________ Pace University – Lenox Hill Hospital Physician Assistant Program Health Care Experience
  5. 5. Name: ______________________________________ SS #: ______________________ Give the following information for all health care related positions held: Hours per Total hours From To Position week completed Total Hours of Health Care Experience ____________________________ * If you have not had health care experience you must complete at least 200 hours by June 30 of year one of the program.

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