ORANGE COUNTY COMMUNITY COLLEGE OFFICE OF ADMISSION
MIDDLETOWN, NEW YORK 10940
Fall 2011 Physical Therapist Assistant Admissions Eligibility Form
This form must be filled out by students wishing to be considered for entry into the Physical Therapist Assistant Program in Fall 2011
and returned to the Admissions Office by February 1, 2011 for consideration.
Name (Please print legibly):_________________________________________________ Student ID#: A
Mailing Address:________________________________________________________________
City:_________________________State:_____Zip Code:________ Legal County of Residence:__________________
Phone Number:________________________E-Mail:___________________
______ Date of Birth:_________________
Have you ever been enrolled in a Health Professions program at an Associate’s degree level or higher either at SUNY Orange or
another college? Yes No Program:_______________________________
If yes, did you successfully complete the program? Yes No
Transcripts from all institutions will be reviewed as part of the admissions process. Please list all colleges previously attended:
____________________________________________________________________________________________________________
Admissions Requirements
Academic Requirements:
• High school diploma or GED.
• Eligible to take Freshman English I (ENG 101).
• Eligible to take Elementary Algebra (MAT 101) or equivalent with a 2.0 or higher or have completed Developmental Algebra
(MAT 020).
• Completed Intro to Biology (BIO 110), Anatomy & Physiology I (BIO 111), or Anatomy & Physiology II (BIO 112), with a
grade of 2.0 or better; High School AP Biology (score of 3, 4, or 5) or a passing grade in the Biology CLEP examination
within 5 years (Spring 2006 semester or later).
• Minimum cumulative GPA of 2.0.
Department Specific Requirements:
• Submit Physical Therapy practitioner observation form with essay (15 hour min. with documentation).
• Attendance at a Physical Therapist Assistant pre-admission orientation (includes interview with Dept Chair; Problem solving
activity and discussion). At this orientation, students will receive and sign off on information pertaining to health forms, drug
testing, and criminal record policies. Orientation dates and observation forms are available online at
www.sunyorange.edu/admissions/healthforms.shtml
.
Selection Process
Students will be considered for admission into this program based on the completion of all mandatory eligibility requirements,
highest combination of cumulative GPA and credits completed towards the program (see reverse), and seats available. Students
must meet all of the above requirements to be considered for admission into the program.
All Physical Therapist Assistant Admissions Eligibility Requirements must be completed before February 1
st
in order for a
student to be considered for acceptance into the program for the fall semester.
Student Certification and Signature (please check one of the following)
:
I have attended a pre-Admissions Orientation and completed my observation within 3 years of my planned program start date
(Fall 2008 semester or later).
I plan to attend/have attended a pre-Admissions Orientation this year. Include date attended/plan to attend (mo/yr)____________
My signature acknowledges that I have read and accept the admissions requirements listed above, and that all of the information
provided is accurate and complete. (When emailing this form, you acknowledge the requirements by typing your full name and date.)
Student Signature
Date:
For Office Use Only: Accept _________Alt_______ Checklist_______ Low Cum_______ No Deposit _____ Declined ____
Dept Chair/Designee Signature Date:
Admissions Signature Date:
