Physical Therapist Assistant Application
Physical Therapist Assistant Application Rogue Community College Rogue Community College (RCC) has developed a partnership with Lane Community College (LCC) to provide training for Physical Therapist Assistants in Jackson and Josephine counties. This program offering has obtained approval by the Commission on Accreditation in Physical Therapist Education (CAPTE) as a distance cohort of the LCC PTA Program. This program will prepare students to function as competent entry-level Physical Therapy Assistants in a variety of practice settings and to pass the National Physical Therapist Assistant Examination (NPTAE) administered by the Federation of State Boards of Physical Therapy. This program will provide an Associate of Applied Science degree awarded by Lane Community College, with RCC offering program prerequisites, general education, and related coursework. Financial Aid is accomplished through the LCC Financial Aid office using an Individual Consortium Agreement between RCC and LCC. Contact the LCC Financial Aid office for details. A maximum of up to 10 students move through the LCC program as a distant site cohort. Students use a distance education (DE) model of accessing the Physical Therapist Assistant (PTA) program-specific courses through LaneOnline. The entire program can be completed while a student is living in the local area (Jackson and Josephine counties) with a combination of RCC classes and the LCC distance education events. The curriculum includes classroom, laboratory, and clinical components. The program is designed to be completed within two years and students must fulfill all requirements within five years of admission into the program. Clinical placements are determined by the LCC Academic Clinical Coordinator and will depend on availability of sites. Students may have to travel out of their immediate geographic area to a location in the Pacific Northwest. Important Program Dates: Classes begin Fall Term 2015 and continue through Spring Term 2017 Application Dates: We will begin accepting applications May 25th, 2015 Applications must be submitted by June 19th, 2015 at 5:00 pm See page 2 for information regarding the online application questionnaire and submitting supplemental materials. Interviews: Students who score highest in the application process will be invited for an interview (12-20). Interviews will be conducted June 29 – July 2, 2015. Admission Decision: Students will be notified via email the week of July 6th, 2015 regarding acceptance into the program. Mandatory Orientation: Admitted students will receive information on the day, time, and location of this orientation to be held at RCC’s Table Rock Campus. RCC PTA Application 2015 Page 1 Physical Therapist Assistant Application Application Instructions Before completing the application Review Physical Therapist Assistant Prerequisite requirements listed on the RCC web site and obtain academic advising from RCC PTA Navigation Coach: contact Daniel Wu 541-245-7845. Complete observation requirements (25 minimum in two clinical settings) See Observation Verification Form for additional information. (See pg. 3 for Work/Observation requirements). If you have never taken courses at RCC complete the online admission application: http://www.roguecc.edu/Students/start.asp to obtain a student ID number. Complete LCC online admission application: http://www.lanecc.edu/counseling/steps-enroll and Financial Aid application. You can contact Lane’s Financial Aide Department at 541-463-3100 or go to http://www.lanecc.edu/sites/default/files/finaid/forms/1314guide.pdf for instructions on how to apply. Request official transcripts from prior colleges/universities for any non-RCC coursework that will be used to meet prerequisite courses or placement requirements. Official transcripts must be received by RCC in the original sealed envelope. You may use the Lane Transfer Tool to confirm LCC transfer equivalency. Application Requirements: Email submissions to [email protected] Apply to RCC with the appropriate student profile. Complete Online PTA Application and submit via email a printed copy of the confirmation page. Submit Official Transcripts for all non-RCC courses used for prerequisite requirements. Complete and Submit via email Work/Observation Forms. Complete and Submit via email Written Personal Statement of Interest. Submit via email proof of Jackson/Josephine Co. residency, veteran/eligible spouse of veteran, or Trade Act eligibility. Submit via email copies of Healthcare License or Certification(s). Application Packet The following must be received on or before June 19, 2015 at 5:00 pm by email: 1. Online Application Questionnaire 2. Official Transcripts (if using non-RCC courses to meet prerequisite requirements). Items 3 -5 must be emailed to: Christine Morris [email protected] 3. Observation Report Form and signed Verification Forms. 4. Written Personal Statement of Interest. 5. Additional Documentation: Proof of Jackson/Josephine County residency, Veteran’s (DD 214 or 215) or Trade Act Affected (Forms 858 and 028) eligibility documentation. 6. Healthcare license and or Certification and a brief description of Healthcare work/volunteer experience. RCC PTA Application 2015 Page 2 Physical Therapist Assistant Application Work/Observation Requirement Information RCC ID # _______________Last Name ______________________________ First ___________________ Print this document, record the necessary information, and submit along with your signed verification forms (page 6) in your completed Application Packet: Agency Name Therapist Name & Phone number Setting # of hours Enter in the right hand column the total number of Work/Observation Hours (Minimum 25 hours) The minimum requirement for work/observation is 25 hours. Additionally, hours must be obtained from at least two different clinical settings. Settings may be described as the following; 1. Outpatient, 2. Skilled Nursing Facility and 3. Acute Care (Hospital). Acknowledgement Statement – RCC program coordinator may contact agencies listed above to verify hours and experience. I understand that any inaccuracies in reporting work/observation hours could result in invalidating my application. RCC PTA Application 2015 Page 3 Physical Therapist Assistant Application Points Breakdown Prerequisite coursework Note: points will be awarded based upon completion of all prerequisite requirements. The following courses or their RCC or LCC equivalents must be completed with a grade of “C” or better. Math Requirement (Completion of Math 065 Course or Placement Test at Math 095 or higher is the minimum requirement) Math65 Placement testing at Math95 or higher, a higher level math class must be completed to obtain degree Psychology Requirement PSY201 or 202 General Psychology Medical Terminology Requirement MO100 Medical Terminology Anatomy and Physiology Requirement (BI121 minimum requirement) BI121 Elementary Anatomy & Physiology I BI231 Anatomy and Physiology I Writing Requirement (WR 121 minimum requirement) W 121 English Composition I or higher Prior Bachelor’s Degree (Submitted with transcript) Physics Requirement (One course from the three options listed below) GS104, PHY201 or PHY202 Additional points will be offered in the following categories: Military Veteran or eligible spouse/ Or Trade Act Affected Employee (Submission of DD 214 or 215 required) (Submission of Forms 858 and 028 required for Trade Act) 4 points possible for above two categories Healthcare work experience (Paragraph describing experience and hours worked plus copy of license or certification if applicable)-0-5 points Personal Statement of Interest (Maximum 2 page response) – 0 – 5 points Interview-(Applies to 12 maximum finalists invited to interview) Group Interview rubric-0-28 points Interview Questions-0-45 points Residents of Jackson/Josephine County will be given preference, verification documents required. See page 7 RCC PTA Application 2015 Page 4 Physical Therapist Assistant Application Any ties between qualified applicants with the same point totals will be awarded first to Veteran’s or eligible spouses and Trade Act eligible applicants; additional ties will be decided based upon the applicants’(a) number of points for Personal Interest Statement, then (b) most recent term’s GPA as a full-time student. Write a Personal Statement of Interest and include it in your application submission, more information included in online application. The personal statement allows you to tell the selection committee about yourself and your personal/professional goals. The American Physical Therapy Association embraces as its core values accountability, altruism, compassion and caring, excellence, integrity, professional duty and social responsibility. Consider your experiences with physical therapy – choose one experience and explain what you observed and how you believe these core values were demonstrated. Include in your response how this experience may have shaped your short and long-term professional goals. Your response must be limited to 2 typed double pages (front/back) and must be double-spaced, 12 point font. Include your RCC ID #, Last Name, First Name as a header on all pages of your personal statement. The personal statement is used in screening candidates. This is a competitive program, and not all qualified applicants may be accepted. The quality of your statement will be assessed from 0 – 5 points. Assessment categories include; Idea and content, Organization and Subjective. Include this document in your completed Application Packet via email. Plagiarism is considered a serious offense at RCC. If it is determined that your essay has been plagiarized or purchased, you will be eliminated from consideration for the program. In compliance with state and federal laws, Rogue Community College does not discriminate on the basis of race, religion, color, national origin, age, sex, Veteran’s status, sexual orientation, marital status or disability in employment, or in any of its educational programs or in the provision of benefits and services to students. This project was funded $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance Community College and Career Training Grants, as implemented by the U.S. Department of Labor’s Employment and Training Administration. Rogue Community College is an equal opportunity employer/program. Auxiliary aids and services, alternate form and language services are available to individuals with disabilities and limited English proficiency free of cost upon request. RCC PTA Application 2015 Page 5 Physical Therapist Assistant Application Observation/Work Experience Verification Form Note to Applicant: Observation/Work Experience must be verified using this form. Be sure to complete the boxed areas prior to submitting this form for verification. If this form is not signed it will not be considered. Dear Human Resources, I am in the process of making application to the Physical Therapy Assistant Program offered by Rogue Community College in partnership with Lane Community College. The application process requests verification of direct observation of Physical Therapy. Experience may take place in one or more locations. Please fill in the information in the area below. The following information may be helpful in locating my records. _______________________________________ Applicant’s name while at your facility _________________________ dates at facility OBSERVATION EXPERIENCE: For Observation Experience, this form must be completed by the PT or PTA overseeing the Observation/Work Experience. Please verify the setting, dates and hours the applicant observed direct Physical Therapy services (assessments or treatments) under your supervision within the last 2 years (since April 2012). Be sure to completely fill out all applicable fields. Incomplete forms cannot be considered in the application process. Eligible Settings: Acute (Hospital), Skilled Nursing, and Outpatient This section to be completed by the facility employee verifying applicant’s Experience □ Acute Setting: Dates of service: Supervised by: Name of Facility: Facility Address: □ Skilled Nursing □ Outpatient ________________________________ Hours of service: __________________ _________________________________________________________________ Name Title Phone _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Authorizing Signature: ___________________________________ Date: _____________________ I authorize the college to contact the individuals listed on this form to verify the information provided. Student Signature: __________________________________ Date: ___________________________ Please duplicate this form as needed. RCC PTA Application 2015 Page 6 Physical Therapist Assistant Application Jackson/Josephine County Residency Documentation Verification for preference in the application process: A resident is defined as someone who established residency 90 days before the first day applications are accepted for that program. Permanent residence is defined as the home a person intends to return to after any absence, and in which one’s dependents reside for an unlimited period of time. You must complete the residency information below and provide at least one document from Category 1 AND one document from Category 2 to prove your permanent residency status. CATEGORY 1 (One of A, B, or C) A. Rent receipts with your resident address and dates of occupancy for the period of time in question. (Rental agreements are not acceptable) B. Power company receipt with your resident address and dates of occupancy. C. Documents proving your own Oregon property and that this property is your primary residence. CATEGORY 2 (One of below) Oregon driver’s license. Oregon vehicle registration with your resident address. Oregon state income tax return (for previous year) with resident address. Verification of local bank account showing resident address. Oregon voter registration. Oregon Hunting/Fishing license. ALL documents must have your name and permanent address for the period of time in question. The address on these documents must agree with the permanent address on your application form or the previous addresses you have listed below. COMPLETE THE INFORMATION BELOW Name_________________________________________________Phone_________________________ ID # or SS# __________________________________________________________________________ Program for which you are requesting to establish your residency _______________________________ Please list all addresses you have lived at for the time period involved. ____________________________________________________________________________________ Street City State Zip ____________________________________________________________________________________ Street City State Zip ____________________________________________________________________________________ Street City State Zip List the two documents you are submitting to verify your permanent address. Category 1 ________________________________ Category 2 _________________________________ The above information is a true and accurate statement of my residency. Student signature RCC PTA Application 2015 Date Page 7
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