Application Deadline

							Application Deadline                     Sacramento City College                APPLICANT, PLEASE
    is April 15!                     Science & Allied Health Division           COMPLETE BOX:
                                                                                Did you apply last year?
                                 Physical Therapist Assistant Program             Yes             No

                                     Fall 2012                                  If so, what was your status?
                           APPLICATION FOR ENROLLMENT                               Alternate    Not eligible
Please Print or Type:
Name:
       Last                                       First                                   M.I.


Previous last names(s) that may appear on your records:
Mailing Address:
                      Street                                City                  State               Zip Code

Telephone:            (Cell)                       (H)                                    (W)

Email:                                                     Birthdate: Month           Day           Year
Social Security # (last 4 digits):                         LRCCD Student ID#:

List all regionally accredited colleges or universities attended, including those in the Los Rios district:
Name of Institution            City & State               Dates of Attendance        Degree Received and Date




You must provide the following information for the prerequisite courses. Completion of all prerequisites
is required in order to be considered eligible for enrollment, with the exception that the final semester of
anatomy/physiology may be in-progress at the time of application. Official transcripts must be submitted
for each school attended.
Required Prerequisites:        College                       Course Name &        Semester & Year Grade
                                                             Number               Completed
Anatomy/Physiology
(BIO 430 or equivalent)
Anatomy/Physiology
(BIO 431 or equivalent)
Introduction to PTA
(PTA 100)
College Composition
(ENGWR 300 or ESLW
340)
Reading requirement. Check one of the following:
     a. Completion of ENGRD 110 (Comprehension Strategies and Vocabulary Development for College) with
                 at least a “C” as indicated on transcripts.
     b. Reading assessment indicating eligibility for ENGRD 310 (Prose Analysis and Interpretation) has been
                 completed and the assessment results are attached.
      c. Transcripts indicate that an AA or AS degree or higher has been granted.
Have you met with a counselor at SCC to develop an educational plan?        Yes           No
If you have a written educational plan, please enclose a copy with your application.

The courses listed below are not required as prerequisites for enrollment. However, they are a part of
the required program for all students graduating with the Physical Therapist Assistant major. If you
have already completed any of these courses, please indicate below.
 Course:                               College               Course Name      Semester & Year     Grade
                                                             & Number         Completed
 Human Development: A Life
 Span (Psych 370 or FCS 324)
 Introductory Sociology (Soc
 300) or/ Cultural
 Anthropology (Anth 310)
 Nutrition (FCS 340 or NUTRI
 300) or/ Health Science
 (HEED 300)
 Communication for Allied
 Health Careers (AH 106)
 Professional Ethics of Health
 Team Members (AH 100)


The courses listed below are not required as prerequisites for enrollment. However, they are required
for all students graduating from the college*. Please indicate which of the following Sacramento City
College Graduation Requirements you have already completed:
 General Education Graduation                    College       Course Name      Semester &        Grade
 Requirement:                                                  & Number         Year
                                                                                Completed
 American Institutions - 3 units
 SCC Graduation Requirement Area Va
 Ethnic/Multicultural Studies** - 3 units
 SCC Graduation Requirement Area VI
 Humanities - 3 units
 SCC Graduation Requirement Area I
 Communication and Analytical Thinking -
 3 units
 SCC Graduation Requirement Area IIb
 Physical Education - 1 unit
 SCC Graduation Requirement Area IIIa
 Reading Competency

 Mathematics Competency
* Students with a prior AA/AS or BA/BS degree may have already met many or all of these requirements and
should check with a counselor to confirm equivalency of prior coursework.
**Some history courses fulfill both American Institutions and Ethnic Multicultural Studies requirements.
Information on Ethnic Background and Gender is requested for statistical purposes. Providing this
information is voluntary and does not affect program eligibility.

      Ethnic Background                 (check one)            Gender       (check one)
 1    American Indian/Alaskan Native                           Male
 2    Asian or Pacific Islander                                Female
 3    Black (not of Hispanic Origin)
 4    White (not of Hispanic Origin)
 5    Hispanic
 6    Filipino
 7    Other
 8    Decline to provide

Important information:

This is a vocational program in which supervised clinical experience in a variety of healthcare settings
is a part of the educational experience. Students admitted for enrollment to the program will be
required to submit evidence of documentation required by clinical facilities. Such documentation
includes background check, drug screen, evidence of physical examination, immunizations, current
Health Care Provider level CPR certification, First Aid training, and Bloodborne Pathogen training.
Detailed information on these requirements will be provided to students accepted for enrollment.

Prospective students should be aware that the Physical Therapy Board of California requires
applicants for licensure to disclose history of misdemeanor or felony offenses, and undergo a
background check for criminal convictions from the Federal Bureau of Investigations (FBI) and the
California Department of Justice (DOJ).

“I have reviewed my application for accuracy and completeness and have read the important
information noted above. I declare that the information contained in this application and copies
of all documents submitted in connection with this application are true and correct. Sealed
official transcripts are enclosed or have been requested.”

Signature of Applicant
Date of Signature
Submit application and transcripts directly to:
Beth Chape, PT, PhD; Physical Therapist Assistant Program Coordinator; Sacramento City College,
Science and Allied Health Division; 3835 Freeport Blvd., Sacramento, CA 95822

For Office Use ONLY:
                                     Sacramento City College
                               Physical Therapist Assistant Program

                  Application Instructions and Enrollment Information

PROGRAM ELIGIBILITY
To be eligible for acceptance for enrollment in the Physical Therapist Assistant Program the applicant
must:
1) Have completed the following courses with grades of “C” or better, and a minimum cumulative
       GPA of 2.5:
    PTA 100, Introduction to Physical Therapist Assistant, 1.5 semester units
    BIOL 430 & 431, Anatomy and Physiology, or equivalent courses. A minimum of eight
      semester units of anatomy and physiology, completed within the past ten years, is required.
      Students who have completed at least four units of anatomy/physiology and have the remaining
      units “in progress” at the time of application are eligible to apply. If accepted for enrollment,
      these students will need to provide updated transcripts verifying satisfactory completion of
      anatomy/physiology by the end of spring semester.
    ENGWR 300 (or ESLW 340), College Composition, 3 semester units.
                                                   AND
2) Be eligible for ENGRD 310 (Prose Analysis and Interpretation) as determined either by the reading
       assessment process or completion of ENGRD 110 (Comprehension Strategies and Vocabulary
       Development for College) with at least a “C”. Students may also fulfill this requirement by
       submitting official transcripts that indicate completion of an AA or AS degree or higher.

PROCESS FOR APPLICATION FOR ENROLLMENT
Students apply for enrollment to the program during Spring Semester and enter the program in Fall
Semester. Students wishing to apply for enrollment must submit application materials to the Science &
Allied Health Division, PTA Program, between March 1 and April 15. The application materials which
must be submitted by the deadline of April 15 include:
1)     APPLICATION FORM
       The form can be printed out and then completed by hand in legible printing. The form can also
       be completed on the computer and then printed out. All required information on the application
       form must be completed. Applications must be signed and submitted by standard mail.
2)     TRANSCRIPTS
       One copy of sealed official transcripts of college work must be provided. (Students accepted
       for enrollment in the PTA program will be asked to submit a 2nd copy of official transcripts.)
       Option 1:       Students may submit sealed official transcripts along with the application in one
                       large mailing envelope.
       Option 2:       Students may request that their school send official transcripts directly to the
                       coordinator of the Physical Therapist Assistant Program. (Even students who
                       have completed prerequisite course work at SCC must follow this
                       procedure. The Admissions and Records office does not automatically send
                       your transcripts.) It is recommended that you enclose a copy of your transcript
                       request receipt with your application.
       Transcripts must be received by the Physical Therapist Assistant Program Coordinator by April
       15 in order for the application to be considered. Students should request their transcripts at
       least 4-6 weeks in advance of this application deadline.
WHERE TO SEND THE APPLICATION AND TRANSCRIPTS
All materials are to be sent directly to:

       Beth Chape, PT, PhD
       Physical Therapist Assistant Program Coordinator
       Sacramento City College
       Science & Allied Health Division
       3835 Freeport Blvd.; Sacramento, CA 95822

If the application is incomplete or transcripts are not received by the program coordinator by the
April 15 deadline, the application cannot be processed.

APPLICANT SELECTION AND NOTIFICATION
All students who meet the program eligibility requirements are placed in the eligible applicant pool. If
there are more eligible applicants than spaces available the class is selected as follows:

       1/3 of the class is randomly selected from the eligible applicants who were ALTERNATES the
       previous year. (An alternate is a student who applied to the program and received a letter
       indicating that they met eligibility requirements and were designated as an alternate in the
       random selection process.)
       The remaining 2/3 of the class is randomly selected from ALL eligible applicants, including the
       remaining previous year’s alternates.

Students will be notified of their enrollment status by May 15. Notification will be by standard mail
only. Phone or email verification cannot be provided. Students who are selected for admission for
enrollment will be asked to accept or decline enrollment in the program by May 25. Eligible students
who are not selected are considered alternates. If spaces become available before school begins,
alternates will continue to be selected and notified by standard mail, based on the number received in
the computerized random selection process. Alternate candidates should notify the PTA Program
Coordinator if their contact information changes in order to ensure that they can be contacted readily if
a space in the program becomes available.

Those students who are alternates and are not selected must re-apply the following year if they wish to
be considered again for enrollment. A new Application for Enrollment form must be completed. New
transcripts should be submitted only if updating is required. All interested students should contact the
program coordinator or attend an information meeting each semester regarding any changes in the
program.