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2013 applic greyregular by HC121106051917

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									             REGULAR ADMISSIONS – STUDENTS WHO WILL HAVE A BACHELOR DEGREE
                             Physical Therapy Departmental Application for 2012/2013
                         Department of Physical Therapy, University of Missouri - Columbia
                                                        http://shp.missouri.edu/pt
                             Applications must be received by January 24 with Fall grades recorded on application.

I. Use the Tab key or Arrow keys to move from one grey-shaded text field to another. Type the information. For Check Boxes,
      type an “X” in the appropriate box. You may need to hit the Enter key at times to keep a text cell from expanding.

 Last:                        First & Middle Initial:       Maiden:               Last 4 of SSN:           Sex: M         F

 Have you applied to MU-PT before?                          Dates:                MU Student #:            Legal Residence:
 Yes      No                                                                                               (State)
 Local Address: Street:                                     City:                 State:                   Zip:

 Telephone:  Daytime: (               )
           Cell
 Permanent Address: Street:                         City:                         State:                   Zip:

 Permanent Telephone:                               E-Mail:
 (     )                                            (MU Students will use their Mizzou account)

II. College(s) attended (Past & Present)                            □ Currently attending MU
 Colleges                        Dates                            Colleges                               Dates




III. Degree(s) completed, or anticipated at the close of this academic year:
 Date             Degree                                                 School




IV. GPA

 1. GPA– Core Required Courses                                Zoology/Biology, Chemistry, Physics, Physiology, Statistics/Higher
                                                              Math, Medical Term (Calculation from VIIIA only)

                                                              Completed/graded coursework will be counted in reverse
  2. GPA-Last 60 Hours of Completed and                       chronological order from the end of the transcript. If 60 hours occurs
       Graded College Coursework                              within the middle of the semester, the entire semester will be used for
                                                              the calculation. Do not include pass/fail courses as you count hours.

V. Confidential Evaluations (Recommendations):
Name, title & location of the two persons (one teacher and one employer or supervisor) who will prepare your
recommendations. Include only two recommendation forms in sealed envelopes with your application packet. Have
each evaluator place the form in a sealed envelope, sign their name over the seal, and then return the envelope to YOU.
It is your responsibility to submit these sealed envelopes with your application. Your application will be incomplete
without the enclosed evaluations.
  Name                    Title                   Address



VI.     Do you consider yourself a minority? No     Yes                 I am:
        Is English your native language? No     Yes


             REGULAR ADMISSIONS – STUDENTS WHO WILL HAVE A BACHELOR DEGREE
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              REGULAR ADMISSIONS – STUDENTS WHO WILL HAVE A BACHELOR DEGREE
                                                Department of Physical Therapy, University of MO-Columbia 2011/2012
 VII. Curriculum Vitae (résumé) – see instructions in the document titled: “General Information for Application”.
       Attach CV to application form.

 VIII. Coursework
 The core required courses for the Department of Physical Therapy Doctoral Degree Program are listed below. Please fill in the chart to
 include core required courses completed and your plan for finishing any remaining courses. All core required courses must be completed
 by the end of the WINTER (Spring) semester (term).

  Courses                            Minimum         Number                     Course Number, Semester/            Course Number, Semester/
                                     Cr. Hrs.        Cr. Hrs.        Grade      Year, and Institution               Year, and Institution
                                     Required        Completed                  WHERE COMPLETED                     TO BE TAKEN
  A. CORE REQUIRED COURSES

  Zoology/Biology with Lab                  4

  Chemistry with Lab                        4

  Physiology with Lab*                      4

  Physics I with Lab                        4

  Physics II with Lab                       4


  Statistics/Higher Math                    3
  Medical Terminology                       1
  * May be met with an Anatomy & Physiology I and II, Anatomy & Physiology I & Exer. Physiology, or Physiology



 IX.        Please address the following question in an organized and thoughtful manner (grey-field will expand as you type).

  1. In this space include any additional information you feel the Physical Therapy Admissions Committee should have as it
     evaluates your candidacy for professional education (up to 250 words).


 X. Health Agreement, Statement of Accuracy, and Signature
 I agree to complete vaccinations, immunization series, tests, CPR and First Aid certification as required by the department prior to engaging in
 clinical activities. The information provided on this application is true and complete at the date of writing to the best of my knowledge.

 ___________________________________________                        ___________________________
    Signature                                                                        Date
                                 Checklist: Send directly to Physical Therapy Department
Return Application to:              Physical Therapy Departmental Application
  Department of Physical Therapy
                                    Curriculum Vitae attached
  Attn: Bev Denbigh
  106 Lewis Hall                   Two sealed Confidential Evaluation of Applicant (Recommendations) enclosed
  University of Missouri            Departmental Application fee of $25.00: payable to University of Missouri
  Columbia, MO 65211-4250          GRE scores received by MU PT Department by January 24th.
                                   Transcripts from all schools attended (fall grades included, except students currently
                                                enrolled at MU Columbia Campus).


 Checklist for Graduate School application:
        □ Submit On-line graduate school application by January 10th , submit application fee to Grad School
              REGULAR ADMISSIONS – STUDENTS WHO WILL HAVE A BACHELOR DEGREE
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