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Physical T

herapist Assistant Program Application Instructions

All applicants must complete a current CCC Physical Therapist Assistant Program Application. The

form

should be completed with care as this application represents you to the Physical Therapist Assistant

Program Faculty. Prior applications will not be included in your current file.

For the Physical Therapist Assistant

Program Application to be considered complete, the applicant must

include the following:

 CCC Admission Application

– If not currently enrolled in CCC, complete an

Application for Admissions to Clovis Community College and return it to the Office

Admissions and Records by July

1st. Your Physical Therapist Assistant Program

Application will not be processed if you do not have a current application for Admission

on file.

 Physical Therapist Assistant

Program Application – Complete all sections of the Physical

Therapist Assistant Program Application, including the transcript information and observation

hours log.

 Transcripts –

Official copies of high school and all college and university transcripts must be

sent directly to the Office of Admissions and Records and arrive prior to July 1st. If you are not

a high school graduate, official GED scores are required. Send Official Transcript to

Clovis Community College, c/o Office of Admissions & Records, 417 Schepps Boulevard

Clovis, New Mexico 88101.

 Grade Point A

verage – Applicants must have a minimum cumulative grade point average

(GPA) of 3.0 including all colleges and universities attended.

 Prerequisite Courses –

You must have completed all pre-requisite courses as detailed on the PTA

degree plan prior to e

nrollment in to the PTA program. Applicants who are enrolled in the last of

these prerequisites at the time of their application may be considered but the courses must be noted

as in progress with the anticipated completion date being prior to the Fall Semester.

 BIOL 211 (

Human Anatomy and Physiology I), BIOL 212 (Human Anatomy and

Physiology II),

MATH 113 (Math for General Education), and NSG 105 (Medical

Terminology) must have been

completed within five years from semester of application.

 Observation Hours –

All applicants must complete at least 25 hours of observation with a

Physical Therapist or Physical Therapist Assistant and document completed hours on the

Observational Hours Log Sheet found on the PTA webpage which must be submitted with the

application.

Physical Therapist Assistant Program Application files, which do not contain all of the requirements listed above

by July 1st, are considered “incomplete”. The incomplete applications will not be reviewed for acceptance by the

Physical Therapist Assistant Program. The application review process will ensure that the Program is blinded to

student identifying information.

Selection Procedure

Applicants for the Physical Therapist Assistant Program will be selected based on the PTA Admissions Criteria Point

System located on the CCC PTA Program Webpage. Applicants who are ranked highest after the initial screening will be

scheduled for the Health Occupation Entrance Test by the Allied Health Department. Following the test, rankings will be

realigned and final selection will occur based on rank.

Applicants are responsible for meeting with an Academic Advisor to file a current Physical Therapist Assistant degree plan

and to review the information contained in the Clovis Community

College Catalog. The policies and regulations contained

in this catalog apply to all applicants, including those who have filed and are following degree plan requirements of an

earlier catalog.

Some policies and requirements may be subject to change based on program requirements. If you

have any

questions regarding the degree plan, contact the Academic Advising Center, located in

the Dr. H.A. Miller Student

Services Center, or call (575)-769-4020.

Accreditation Statement: Graduation from a physical therapist assistant education program accredited by the

Commission on Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria,

VA 22314; phone; 703-706-3245; accreditation@apta.org is necessary for eligibility to sit for the licensure

examination, which is required in all states.

The Physical Therapist Assistant program at Clovis Community College 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: http://www.capteonline.org.

NOTICE

All of the Health Science Programs at Clovis Community College require criminal background

checks and drug

screenings prior to admittance into the clinical setting. Failure to pass one or

both could result in dismissal from

the program. Applicants with felony convictions and

certain

misdemeanors may not be allowed in the clinical

sites or allowed to sit for the National Physical Therapist Assistant Examination.

TECHNICAL STANDARDS FOR ACCEPTANCE

To participate in the clinical education portion of the program, the applicant must possess

additional non-

academic skills. These technical standards are consistent with the duties of the

entry level physical therapist

assistant in a professional position. The applicant must be able to:

•

Lift and transfer patients to and from surfaces.

•

Move, adjust, and manipulate equipment to perform procedures.

•

Communicate effectively in an oral or written format, and follow written and verbal directions.

•

Use proper discretion and judgment in dealing with patients and others.

•

Think clearly and rationally. Students cannot be in clinical practice while under

influence of

prescribed medications which could affect decision making and

ultimately jeopardize patient

care.

•

Work harmoniously with others in a team while maintaining a high level of

enthusiasm.

TRANSFER STATEMENT

Any student who is seeking to transfer from another Physical Therapist Assistant Program will be considered

with full application procedure and leaving the previous program in good academic and conduct standing.

All students who are seeking to transfer from another program will be expected to complete the CCC PTA

program in its entirety.

Applicant

Information

Note: If you change your address or telephone number, you must notify the Admissions

and Records Department in a timely manner.

Is this your rst application to the program: Yes_____ No_____

If no, list the year of previous application: ____________________

Have you attended another college since your last application: Yes____ No____

Where did you attend_______________________________________________________

________________________________________________________________________

If yes, you must request an ofcial copy of your transcript(s) to be mailed to the Ofce

of Admissions and Records, or you may walk in an ofcial, sealed copy.

First Middle Last (Maiden)

Date of Birth

Address

City/State/Zip

Please print legibly

Primary Phone

Secondary Phone

CCC Email (required)

Name

Phone

Name

Phone

Contact Information Emergency Contacts

Signature

Applicant's Signature Date

Revised

January 2018

 Male  Female



Home



Cell

 Home  Cell

For important application and transcript deadline information, please refer to

the PTA Program insert.

Please print legibly, fill out completely. List additional information on separate sheet if necessary.

Physical

Therapist Assistant

Program Application 2019

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Provisional

Agreement

I understand that my application to the Physical Therapist Assistant Program at Clovis

Community College is on a PROVISIONAL BASIS pending receipt of transcripts from the

following school(s)/college(s)

I agree to complete my Physical Therapist Assistant application file no later than the

published deadline. (Deadlines are published on the insert contained in this packet) I

understand that if my file is not complete by the published deadline it will not be

forwarded to the Physical Therapist Assistant Selection Committee

Applicant’s Signature: Date:

______ I understand that all corrospondance regarding my application, admission testing

and acceptance into the Physical Therapist Assistant

Program will be conducted through

CCC email. Failure to check my CCC email may result in missed information or

deadlines.

Initial:

Your record of paid employment is a consideration. Please describe work history by listing your most

recent employment first.

Work

History

Information

Place of Employment Dates of Employment

Position Reason for Leaving

Job Duties

Place of Employment Dates of Employment

Position Reason for Leaving

Job Duties

Correspondence

Acknowledgement

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signature

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