PHYSICAL THERAPIST ASSISTANT PROGRAM TECHNICAL PORTION APPLICATION 2021
For admission into the technical portion of the PTA program in Fall 2021 you must complete and submit this form AND all
requested/required documents by January 31
st
, 2021, for consideration by MERIT, or by March 31
st
, 2021, for consideration
by DATE BASED. If applying for Date Based interview, you must submit all application materials to Dr. Damian Rankin, DPT in
the Health Science Building room 203 A/B. If applying for Merit Interview, follow the instructions for completing the PTA
Merit Interview Application, including submission of the application materials to Dr. Rankin AND Molly Shealy, Merit
Admission Coordinator, Student Center Room 221. For either application method, Dr. Rankin is to receive the signed original
MTC PTA program observation hours forms and reflection paper.
Student Name: ____________________________________________ Student ID#: ____________________
Reliable Daytime Phone Number: _____________________________
Current Address: ___________________________________________
Reliable Email Address: ______________________________________
Date of mandatory advising appointment: ______________________
Attendance date of mandatory PTA info session: _________________
Anticipated completion date for all Phase I courses: __________________________________________________
Check here if applying by Date
Attach a copy of:
• MTC online transcript
• Transfer transcript summary from MTC online
• Completed Observation forms and Impression Paper
To be offered a seat in the program, all general education
courses must be successfully completed by End of Spring
semester 2021.
Students who have met eligibility criteria may be selected
for interview according to the following dates:
• PTA General Education coursework completion date
• Submittal of completed observation requirements
Students with the earliest dates will be considered for
interviews first. Submit your information to Dr. Rankin in
Health Science Building Room 203 A/B.
Check here if applying by Merit
Attach a copy of:
• Merit Application
• MTC online transcript
• Transfer transcript summary from MTC online
• Completed Observation forms and Impression Paper
• Verification of prior work experience (if applicable)
All general education courses must be successfully
completed by End of Fall semester 2020.
Students who have met eligibility criteria are selected for
interview according to accrued merit points.
Follow instructions on the PTA Merit Interview
Application including submission of application materials
to Dr. Rankin and Molly Shealy, Merit Admission
Coordinator, Student Center, Room 221.
This form and all information and documents requested must be submitted to the proper person/people to be
considered for date-based interview or for merit interview. Application materials that are submitted
incomplete, incorrectly, or after the application deadline may result in non-consideration.
