KU

MASTER OF SCIENCE IN PHYSICIAN ASSISTANT PROGRAM SUPPLEMENTAL APPLICATION
FOR JANUARY 2014 START DATE
DEADLINE FOR APPLICATION: NOVEMBER 1, 2013

General Information

Name:

Street:

City: State: Zip:

Email: Current Phone:

SS#: xxx-xx- Primary language spoken at home (required):

Questions:

Please answer the following questions.

1. Explain specifically why you want to attend Keiser University's Physician Assistant Program. (Essay):

2. Explain any gaps of greater than one year in your resume:

3. Have you ever been enrolled in another PA program? if so, which program? When?

4. Please explain any withdrawals, failures, or leaves of absence on your transcripts:


Pre-Requisite Courses:

You must include course name and number for each pre-requisite. Keiser University does not accept pre-requisites with a grade of C- or lower in both General Ed and Science Courses.

General Ed
Pre-Req/Credits
Course Name
Course No.
College/University
Semester
Compl'd
Year
Compl'd
Grade
Recv'd
Credit
Recv'd
College Math(3)
English Comp (3)
English (3)
Humanities (3)
Behavioral Sci (3)
Behavioral Sci (3)
Social Science (3)

Pre-Requisite Courses (Continued):

Science pre-reqs must have been completed within the last 10 years.

Science
Pre-Req/Credits
Course Name
Course No.
College/University
Semester
Compl'd
Year
Compl'd
Grade
Recv'd
Credit
Recv'd
General Chem I (3)
General Chem Lab (1)
General Chem II (3)
General Chem II Lab (1)
Biochemistry or Organic Chem (3)
Gen Biology (3)
Gen Biology Lab (1)
Microbiology (3)
Microbiology Lab (1)
Genetics (3)
A&P I (3)
A&P I Lab (1)
A&P II (3)
A&P II Lab (1)

Acceptance Policy:

  • I understand that if I have college/university transcripts from non-U.S. institutions, they must be evaluated.
  • I understand that official transcripts for all in-progress course work and degree completion must be submitted to the Graduate Office of Admissions at Keiser University prior to matriculation.
  • I understand that if I am offered a seat, I must respond with my acceptance within two weeks (14 calendar days).   I must also pay in full a $1,000 deposit within two weeks of my acceptance.
  • I understand that if I am accepted, Keiser University will conduct a criminal background check.
  • I understand that graduation from Keiser University Physician Assistant program does not guarantee state licensure.
  • I understand that if I am accepted into Keiser University Master of Science in Physician Assistant Program, I must provide FileMD with up-to-date drug screens and immunization records.
  • Conferred Bachelor’s Degree by December 31, 2013.


Name/Electronic Signature By typing your name you have created an electronic signature as legally binding as your handwritten signature.