Health Sciences Department

Kapi`olani Community College PHYSICAL THERAPIST ASSISTANT PROGRAM Admission Application Checklist Application Period: April 1 – May 25 Directions: Please complete each item carefully and submit this Admission Application Check List and all required documents to a Health Sciences Counselor during office hours at the Health Career Counseling Center in Kauila 106. Submit this Admissions Application Checklist and all required documents in a sealed 9” x 12” envelope, labeled “PTA Application” with your name on the envelope to the Health Sciences Office (Kauila 106) by 4:00 pm, May 25 (or the next business day). Only this fully completed program Admission Application Checklist submitted to the Health Career Counseling Center (Kauila 106) by May 25th (or the next business day) will be considered for the program acceptance process. APPLICANT INFORMATION Name:

UH Number/Username Last Name

First Name

M.I.

Mailing Address: Street / POB

City

State

Zip Code

Phone: Cell

Home

Work

UH SYSTEM Email Address: List other name(s) used on documents: (Notify the KCC Kekaulike Information & Service Center regarding other names used on college documents.)

ADMISSION APPLICATION CHECKLIST FOR PTA PROGRAM 1.

Attend a mandatory PTA Program Information Session within one year prior to the close of the application period. For more information visit www.kapiolani.hawaii.edu or pick up an Information Session schedule from Kauila 122 or Kauila 106, Monday – Friday from 8:00 AM to 4:00 PM. Date Attended:

(Month / Day / Year)

2.

Complete the online UH System Application (New, Returning or Transfer) if you are not currently enrolled at any UH System institution. (http://apply.hawaii.edu)

3.

Prerequisite Courses must be completed by application deadline. Prerequisite courses must be completed with a grade of “C” or higher by May 25.

4.

Student copy of transcripts (for course work WITHIN the UH System). UH system colleges and university transcripts are downloadable from the internet (MyUH Portal). Student copies of transcripts must be submitted with this checklist.

5.

College transcripts for courses completed outside of the University of Hawai‘i System Official transcript(s) should be sent to the KCC Kekaulike Information & Service Center.

6.

• Institution:

Transcript Request Date:

• Institution:

Transcript Request Date:

• Institution:

Transcript Request Date:

Please indicate any previous degree(s) earned: Bachelor's Degre Master's Degree Doctoral Degree 6/29/2015

Health Sciences Department

7.

Request for Transcript Evaluation Form - A request for transcript evaluation must be completed for coursework outside the UH System. Completion of this form is required in order to transfer credits to KCC. This form can be obtained at the Kekaulike Information & Service Center (‘Ilima 102) or online at: http://www.kapiolani.hawaii.edu/admissions/admissions-toolbox/ (see Request for Transcript Evaluation)

8.

Clinical Observation Reference. Original reference sheet of the minimum 20 hours of volunteer work or observation in a Physical Therapy Clinic must be attached to this application. Reference sheet is only valid for one year and must be completed in the same academic year as the application period.

9.

“My Plan Initiative.” Complete reflection essays and self assessments for your program/career pathway.

10.

Self-addressed, stamped #10 (4 1/8” X 9 1/2") envelope.

11.

Placed completed application in a 9” x 12” envelope labeled “PTA Application” and your name.

APPLICANT CERTIFICATIONS: I certify that the answers and responses provided for all of the items on this Admissions Application/Check List are true to the best of my knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements and/or discipline measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program of application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change my major and home institution if I am accepted into the PTA program. I understand that if I am not accepted into the PTA program, my home institution and major will not change. “Health care students are required to complete University prescribed academic requirements that involve practice in a University affiliated health care facility setting with no substitution allowable for the completion required clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not satisfying academic program requirements. It is the responsibility of the student to satisfactorily complete any background checks and drug testing that may be required by the affiliated health care facility to which he/she is assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated health care facility.” I have read and understand the notification that a background check and drug test may be required for entry into clinical practice. I also understand that clinical practice is required for completion of this program. ________ (please initial) I have completed, attached, and submitted all necessary application documents and prerequisites at the time of this application. I understand the selection is based on a Best Qualified, First Accepted basis. Print Name ____________________________ Signature ________________________

Date_____________

EXAMPLE of how to complete the application:  These are the requirements 

 Tell us what class you took to meet each requirement 

Course Alpha

Credits

Term of Completion

Where Completed (i.e., Institution Name)

Grade

Points A B C   

PHYSICAL THERAPIST ASSISTANT PREREQUISITES ENG 100 Composition I (3) – Expository Writing I

 Circle Points 

ENG 101

3.0

Fall 2009

Monster University

A

15

5

0

6/29/2015

Health Sciences Department

CRITERION FOR ACCEPTANCE: Qualification is based on a rating system for grades of completed prerequisite courses and observation reference points. Selection is based on total qualifying scores in rank order from the highest until admission quota is met. Students must circle the points based on the grade achieved for that course. Prerequisite Courses OR Equivalent course title from another institution ENG 100 (3) Composition I MATH 103 (3) Fundamentals of College Algebra OR higher. ZOOL 141 (3) Human Anatomy & Physiology I

Course Alpha

Term of Completion

Where Completed

Credits

Grade

(i.e., Institution)

Points A B C 15

5

0

15

5

0

25

10

0

ZOOL 141L (1) Human Anatomy & Physiology I Lab ZOOL 142 (3) Human Anatomy & Physiology II ZOOL 142L (1) Human Anatomy & Physiology II Lab SP 181 (3) Interpersonal Communication

25

5

0

25

10

0

25

5

0

15

5

0

FAMR 230 (3) Human Growth & Development A. S. Humanities (3) (100 Level or higher) HLTH 125 (1) Survey of Medical Terminology HLTH 120 (1)

15

5

0

15

5

0

20

5

0

20

5

0

30

15

0

30

15

0

30

15

0

Introduction to Health Professions

HLTH 290 (2) Kinesiology HLTH 290L (1) Kinesiology Lab PTA 101 (1) Professional Issues I: Intro to Physical Therapy Application Summary: For office use only

Date Received: _____________________

Ethnic Code: ____________

Counselor’s Initials: _________________

Application Complete: _____________

HI Resident:

Y

N

TOTAL Score Courses:

________

TOTAL Score Reference:

________

TOTAL Application Score:

________

KCC GPA Verified: _______________ 6/29/2015

Health Sciences Department

Kapi`olani Community College MY PLAN Reflection Essays Name: _____________________________________  UHID: ________________________________  Program: _______________________________________________________________  Please be clear and concise in your response for each reflective essay, limiting each question to 300 words. 

Career Pathway Preparation  1. In a brief statement describe your career goals in this pathway.  Where do you see yourself in this career pathway in the next three years? 

Health Sciences Department

Career Pathway Attributes  2. In viewing “Health Careers at a Glance”, what are your strongest and weakest “professional qualities” in your chosen career pathway?  Please describe these attributes; how do you plan to overcome your challenges, how do you plan to improve on your strengths?

Health Sciences Department

Career Pathway Outlook  3. Describe any personal obstacles you face that may impact your current academic success and how you plan to overcome these challenges? (I.e. transportation, financial obligations, child care, time management).  What support systems do you have in place to overcome them?

Health Sciences Department

Kapi`olani Community College MY PLAN Self - Assessment The purpose of the self-assessment is to discover your strengths and areas of focus. Working in healthcare requires a combination of academic skills, social skills, and a commitment to public service. As you plan, find ways to make your strengths shine and to improve your weaker areas. Consider discussing your selfassessment and reflective essays with a counselor to understanding how they support your academic and career goals. Academic Strength

Below Expectations

Meets Expectations

Exceeds Expectations

Below Expectations

Meets Expectations

Exceeds Expectations

Below Expectations

Meets Expectations

Exceeds Expectations

Cumulative GPA Prerequisite Course GPA Completed prerequisites Completed support courses Writing ability Letters of evaluation Awards/Achievements Knowledge of the Profession

Relevant experience – volunteer Relevant experience – for credit Relevant experience – paid Relevant Public service/Service Learning Understanding of current healthcare issues Comfort with bodily fluids Comfort with illness Comfort with injury Comfort with death Comfort with physical contact with people Ability to multitask and adapt to change Personal Characteristics

Commitment to public service Empathy/altruism Moral/ethical integrity Emotional maturity Responsibility Leadership Dedication/hard-working Commitment to life-long learning Ability to work as a team Personal interests & experience

HEALTH CAREERS COUNSELING CENTER HEALTH CAREERS @ A GLANCE FOR HEALTH SCIENCES/EMS

UPDATED:

06/2015

All programs give priority seating to qualified Hawai`i state residents. Each student should develop a “My Plan” with the Health Sciences/Nursing Counselor(s) for their intended program/career pathway.

Program

Dental Assisting (DENT)

Emergency Medical Technician (EMT)

Medical Assisting (MEDA)

Medical Laboratory Technician (MLT)

Mobile Intensive Care Technician (MICT)

Health Services Occupational Cluster

Professional Qualities

Starting Semester

Application Period

Selection Process

Selection Criteria

Qualifying Placement Tests

Therapeutic Dental

Professional Attitude Time Management Compassion Flexibility Adapt to Changes Ability to Multitask

Fall

Dec 1 - June 30

Best Qualified, First Accepted

Cumulative Score from Completed Prerequisites

COMPASS Reading score of 74 or higher

ENG 100 or ESL 100 Math 100 (or higher)

SP 151 ZOOL 141 + 141L

None

CA:39

Therapeutic Direct Patient Care

Integrity Empathy Self Motivation Appearance & Hygiene Self Confidence Time Management Communication Skills Teamwork & Diplomacy Respect Patient Advocacy

Best Qualified, First Accepted

Cumulative Score from Completed Prerequisites, Supplemental Application Requirements, & Interview

COMPASS MATH 24 or higher or evidence of completion

English 100 Health 125

MATH 24 or Equivalent coursework

None

CC:13

Therapeutic Patient Care, Health Info & Diagnostic

Compassion Attention to Detail Ability to Multitask, Organizational Skills, Good Verbal & Written Communication Skills Adaptability & Flexibility

Best Qualified, First Accepted

Qualifying Scores/ Courses

COMPASS ENG 22 or higher & COMPASS MATH 24 or higher, or evidence of completion of both

ENG 100 MATH 100 ZOOL 141 + 141L

FAMR 230 AS/AH

None

CC:33 AS:64

Diagnostic Laboratory

Attention To Detail Integrity Dependability Good Verbal & Written Communication Skills Self-Starter Ability To Multi-Task

Best Qualified, First Accepted

Cumulative Score from Completed Prerequisites & Support Courses

None

ENG 100 or ESL 100 MATH 103 or higher CHEM 161 + 161L MLT 100

BIOL 130 or BIOL 171 or ZOOL 141 & ZOOL 142

CHEM 162 + 162L MICR 130 MICR 161 AS/SS AS/AH

AS:70-73

Therapeutic Direct Patient Care

Integrity Empathy Self Motivation Appearance & Hygiene Self Confidence Time Management Communication Skills Critical Thinking * Problem Solving Skills Teamwork & Diplomacy Respect Patient Advocacy

Best Qualified

Cumulative Score from Completed Prerequisites, Supplemental Application Requirements, & Interview

None

ENG 100 HLTH 125 MATH 103 EMT 100 EMT 101

BIO 130 + 130L or ZOOL 141,141L, & 142,142L

FAMR 230 AS

CC:44 AS:69

Information is subject to change without notice.

Fall Spring

Fall

Spring

Spring

Dec 1 - June 1 June 2 - Oct 1

Dec 1—March 1

June 1—Sept 1

June 1—Oct 1 (every other year)

Suggested Degree Support Courses (Credits)

Prerequisites

Updated: 7/9/2015

HEALTH CAREERS COUNSELING CENTER UPDATED:

HEALTH CAREERS @ A GLANCE FOR HEALTH SCIENCES/EMS

06/2015

All programs give priority seating to qualified Hawai`i state residents. Each student should develop a “My Plan” with the Health Sciences/Nursing Counselor(s) for your intended program/career pathway.

Program

Occupational Therapy Assistant (OTA)

Physical Therapist Assistant (PTA)

Radiologic Technician (RAD)

Respiratory Care Practitioner (RESPI)

Health Services Occupational Cluster

Personal Qualities

Therapeutic Rehabilitation

Able to Relate & Engage With People; “people person” Self Motivated & Responsible Organizational Skills Commit To Rigorous Study Communication Skills Critical Thinking Skills Creative & Adaptability Teamwork Skills

Therapeutic Rehabilitation

Accountability Altruism Compassion and Caring Culture Competence Duty Integrity Social Responsibility Communication Problem Solving

Diagnostic Imaging

Communication Skills Compassion Hand-Eye Coordination and Visualization Acute Problem Solving Skills/ Ability to Adapt Function Under Pressure Good Work Ethic

Therapeutic Direct Patient Care

Communication Skills Compassion and Caring Culture Competence Ability to Adapt Ability to Multitask Organizational Skills Problem Solving Skills Integrity Teamwork & Diplomacy Good Work Ethic

Information is subject to change without notice.

Starting Semester

Fall

Fall

Fall

Fall

Application Period

Selection Criteria

Qualifying Placement Tests

Best Qualified, First Accepted

Qualifying Scores/ Courses

COMPASS ENG 100, & COMPASS MATH 24 or higher, or evidence of completion of both

Apr 1—May 25

Best Qualified, First Accepted

Cumulative Score from Completed Prerequisites & Observation Reference Score

Apr 1—May 31

Best Qualified, First Accepted

Cumulative Score from Completed Prerequisites & Support Courses, & A2 Exam

Best Qualified, First Accepted

Cumulative Score from Completed Prerequisites, Interview, Essay, & Evidence of Degree Earned

April 1—May 31

April 1— May 30

Selection Process

Prerequisites

Suggested Degree Support Courses (Credits)

ENG 100 or ESL 100 MATH 100 or higher

BIOL 130, 130L or ZOOL 141,141L + 142,142L

HLTH 125 OTA 110 OTA 119 AS/AH FAMR 230

None

ENG 100 or ESL 100 MATH 103 or higher SP 181 FAMR 230 ZOOL 141,141L, 142,142L

PTA 101W HLTH 120 HLTH 125 HLTH 290, 290L A.S. Humanities Course

None

AS:72

HESI A2 Exam

ENG 100 or ESL 100 MATH 135 or higher HLTH 125

BIOL 130 + 130L or ZOOL141,141L, 142,+142L

AS/AH AS/SS

AS: 89-92

None

ENG 100 or ESL 100 MATH 100 or higher HLTH125 or HLTH110 PSY100 or FAMR230 CHEM100 or higher

ZOOL141,141L, 142,+142L MICR 130 or MICR 135 MICR 140 A.S. Humanities Course

None

AS: 67-68

CC: 5 AS: 70-72

Updated: 7/9/2015