Physical Therapist Assistant Application PTA Registration Form If you are human, leave this field blank. As an applicant to the Physical Therapist Assistant Program at Craven Community College, I have applied to Craven Community College and been accepted. * Yes No If you have not applied to and received your acceptance to Craven Community College, please go to Craven Community College Application. Once you have received your acceptance to Craven CC, please come back and complete this application for the Physical Therapist Assistant Program. If you have any questions, please contact Admissions or contact Health Programs. Date * Student ID # * Enter 7 digit ID Number Legal First Name: * Middle Initial: Legal Last Name: * Additional Last Names Craven Student Email Address * You must include your Craven Community College Email Address. Example: pantherID@my.cravencc.edu. Using an email other than your official College Student Email may delay your application. Mailing Address * City * State * Zipcode * Phone Number * Alternate Email Address High School Attended/GED Earned * Year of Diploma * (YYYY) List all post-secondary institutions attended Military Service * Active Duty Reserve Veteran None Do you have a bachelor degree or higher? * Yes No Bachelor Degree Information Institution * Date of Degree * Name of Degree * GPA * Will you be submitting wok experience documentation by April 30, 2021? * Yes No Have you completed all developmental requirements to be eligble to enroll in ENG 111? * Yes No Have you completed all developmental requirements to be eligible to enroll in MAT 110 * Yes No Have you completed all developmental requirements to be eligible to enroll in BIO 168 * Yes No Have you completed, with a C or above, or are you currently taking the following classes? ACA 111/115/118/122 (College... Success) * Yes No ENG 111 or compatible (Writing and Inquiry) * Yes No BIO 168 (Anatomy and Physiology I) * Yes No BIO 169 (Anatomy and Physiology II) * Yes No COM 120 (Interpersonal Communication) * Yes No COM 231 (Public Speaking) * Yes No HUM 115 (Critical Thinking) * Yes No MAT 110 (Math Measurement and Lit) * Yes No PHI 240 (Introduction to Ethics) * Yes No PSY 150 (General Psychology) * Yes No CHM 090 or higher or High School Chemistry * Yes No I understand that it is my responsibility to send all official transcripts to the Registrar at Craven Community College so that my application can be processed. Please initial below. * Submit
