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.

Pre-Requisite Courses (Continued):

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

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 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, 2012.