Master’s of Science in Physician Assistant Studies Program
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We have provided the attached worksheet for two reasons:
1. To help you organize the courses you have taken according to our prerequisites and
to manage the task of completing all of our course requirements.
2. To help you determine whether a specific course will satisfy our requirements.
Please list the department, exact course number and title, college or university where taken,
number of units assigned to the class, and the grade you earned in the class. You may use
another sheet to list additional courses you believe will meet our requirements. You must
include a course syllabus for each course that is not listed currently in our Prerequisite
Database. To obtain this information, go online or contact the admissions office/registrar’s
office at your undergraduate institution(s) and request a copy of the syllabus for the year(s) in
question.
All information provided on the academic work sheet will be verified for accuracy when the
application is received, and a final evaluation will be made at that time. You will be notified in
writing of the results of our evaluation within three weeks of our receipt of the completed
worksheet. Please provide your name, mailing address, telephone number, and e-mail
address so that we may contact you with any questions. NOTE: Academic worksheets will
not be reviewed during peak application processing time; October through February. If your
worksheet is received during this time, it will be held until March at which time we will be
happy to respond to your questions.
Mail the completed Academic Worksheet to:
Michael Haverkamp (A-L) or Jeanene White (M-Z)
Western University of Health Sciences
MSPA Admissions Office
309 E Second Street
Pomona, CA 91766-1854
OR
Fax the completed Academic Worksheet to:
Michael Haverkamp (A-L) or Jeanene White (M-Z)
(909) 469-5570
OR
Click on the “Submit” button to have the worksheet emailed directly to Admissions
Master’s of Science in Physician Assistant Studies Program
ACADEMIC WORKSHEET
(Pre-evaluation of Prerequisite Course Work)
*This form is not to be submitted in place of the Prerequisite Worksheet when applying*
Required Courses
Name of Institution
(Try not abbreviate)
Dept
code
Course
Number
Complete Course Title
Term/
Year
Units
(Sem=S or
Quart=Q)
Grade
(or IP)
Example:
Freeway University
CHE
101
General Chemistry
F00
4Q
A-
1
College English (3 units)
English Composition (3 units)
1
2
College Algebra (3 units)
3, 8
Human Anatomy (3 units)
Human Anatomy Lab
Only if not included with lecture
Human Physiology (3 units)
3, 8
8
Human Physiology Lab
Only if not included with lecture
8
Microbiology (3 units)
8
Microbiology Lab
Only if not included with lecture
Genetics (3 units)
8
4, 8
General Chemistry I
General Chemistry II
4, 8
4, 8
General Chemistry III
General Chemistry I Lab
Only if not included with lecture
General Chemistry II Lab
Only if not included with lecture
General Chemistry III Lab
Only if not included with lecture
5
Psychology (3 units)
(General or Intro Only)
6
Sociology (3 units)
(General or Intro Only)
7
Humanities I (3 units)
Humanities II (3 units)
7
Humanities III (3 units)
7
Introductory Statistics (3 units)
PROVIDE THE INFORMATION REQUESTED BELOW - PRINT OR TYPE ONLY
________________________________________________________________________________________________________________________________
First Name
Middle Initial
Last Name
________________________________________________________________________________________________________________________________
Street
City
State
Zip Code
Cell Phone (
) _______________________
Email _________________________________________________________
SUBMIT
Notes:
1
Must be out of the English Department. A full year course sequence with emphasis in writing & comprehension. Literature
courses may not be accepted (ESL courses are not accepted for the English prerequisite).
2
Statistics, fundamental, beginning, elementary algebra, or intermediate algebra are not acceptable. May list pre-calculus,
calculus, geometry, or trigonometry to satisfy the prerequisite.
3
Must be out of Anatomy, Physiology, A&P, Biology, or Zoology Departments and MUST INCLUDE AN ON-CAMPUS LAB.
Online/virtual labs will NOT be accepted.
4
Fundamental, introductory, organic, biochemistry, or principles are not acceptable.
5
ONLY General or Introductory accepted. NO exceptions.
6
ONLY General or Introductory accepted. NO exceptions.
7
Examples include Art, Music, Drama, Ethics, Philosophy, Religion, Ethnic Studies, Foreign Languages, and Speech. History is
not recommended to satisfy this prerequisite.
8
All science prerequisites, including labs, must have been completed no more than seven years prior to the application deadline
(i.e. courses completed in 2008 and later will be accepted for the Fall 2016 entering class).