MARQUETTE UNIVERSITY
Supplemental Application Form for Admission to the Master of Physician Assistant Studies Program
Instructions: Please download the document and save it before entering your information. Once you
have saved the document and entered your information, save again before uploading to CASPA.
AUTOBIOGRAPHICAL INFORMATION
Name:
Last Jr., etc. First Middle
If any of your records are under a different name(s), please indicate.
Gender: Male Female
Date of Birth: Marquette I.D. Number (if applicable):
Current mailing address:
Number and Street
City, State ZIP Code
Primary Phone Number: Additional Phone Number:
Current email address:
The current address and telephone are effective until: (Month Day Year)
Are you a repeat applicant? Yes No If yes, which admissions cycle did you apply?
ACADEMIC BACKGROUND
Please include all institutions attended:
Name of Institution City, State Dates Attended Degree Awarded (Ex: Bachelor’s-Major,
Masters-Area of Study, Non-degree)
OPTIONAL QUESTIONS
Special Note: Marquette University admits students based on academic qualifications. Data collected from
optional questions is used for research and provision of special services.
Marital Status Single Married
Citizenship: U.S. citizen Permanent resident Not a U.S. citizen or permanent resident.
Explain:
Ethnicity:
Are you Hispanic/Latino? Yes No
Select one or more: Native Hawaiian or other Pacific Islander White Asian
Black or African American American Indian or Alaska Native
Print name:
Prerequisite Course Requirements: Marquette University undergraduate Sophomore and Junior
Applicants Only who enrolled at Marquette in Fall 2018 or after.
Please complete empty boxes including pending/planned coursework.
Name Date
I certify that the information given on this application is complete and correct to the best of my knowledge and that I have not attended institutions other than those
listed. I understand that I am responsible for arranging for the forwarding of official transcripts from schools I have attended, if required, and that such transcripts
become the property of Marquette University and will not be returned. I understand that any falsification on my records may be cause for the university to void my
admission or registration or to take other appropriate action. I understand that some degrees, majors and/or courses may require me to submit to criminal
background checks and/or drug testing. I further understand that the results of those checks and/or tests may affect my eligibility to continue in that degree, major
and/or course.
Marquette University publishes the Safety Resource Guide, a booklet that includes campus crime statistics and crime prevention strategies. Printed copies are
available from the Department of Public Safety, P.O. Box 1881, Milwaukee WI 53201-1881 or by calling (414) 288-7320.
Marquette University does not discriminate in any manner contrary to law or justice on the basis of race, color, gender, age, sexual orientation, religion, disability,
veteran’s status or national origin in its educational programs or activities, including employment and admissions. At the same time, Marquette cherishes its right
and duty to seek and retain personnel who will make a positive contribution to its religious character, goals, and mission in order to enhance the Catholic, Jesuit
tradition.
Requirements
Course
Number
Brief Course Title
Grade
Credits
Term
EXAMPLE
ENGL 1001
Rhetoric
A
3 cr.
Marquette
Fall 2017
General Chemistry I & II
Organic Chemistry I & II
Biochemistry
General Biology I & II
English I
Intro to Philosophy
Intro to Theology
Human Anatomy
Psychology
Statistics
Medical Terminology
Engaging Social Systems
and Values 1
Foundations in Methods
of Inquiry
Discovery Theme courses