Doctor of Physical Therapy Track 1A Application

1320 W. Lombard Street Davenport, Iowa 52804
563/333-6403, pt@sau.edu, www.sau.edu/pt

Applicants must first complete a separate St. Ambrose University Application for Admission for Undergraduate Students. Apply online at https://sau.edu/admissions/how-to-apply/ or contact the Admissions office.

Please complete each section of the application and hit submit at the end. If you have any questions please contact our office. Thank you for your interest in our program.

First Name

Last Name

Middle Name

Preferred Name

Mailing Address

Country

Street

City

Region

Postal Code

Cell Phone Number

Email Address

Alternate Email Address

Birthdate

Gender

Are you a citizen of the United States?

Yes

No

International Students: Visa holders are subject to federal non-immigrant laws that vary based on type of visa. For information on admission requirements and academic guidelines for your visa type, contact the International Student Services office, global@sau.edu or visit www.sau.edu/international.

The following questions are asked in compliance with Department of Education federal guideline requirements to collect data on ethnicity and race. Information supplied will remain confidential and will not affect admission. Select one or more of the following to describe your racial origin:

Self Describe Race

Ethnicity

Hispanic/Latino

Non Hispanic/Latino

How did you hear about the program? Select all that apply.

High School Attended: Please list all high schools attended starting with the most recent.

Click Here to Add High School

Current unweighted high school cumulative GPA

Extracurricular Activities: Please list most recent first and indicate any leadership roles.

Extracurricular activities encompass a wide range of pursuits undertaken by students outside their regular curriculum, both within and outside the school environment. These activities are typically voluntary and can span a multitude of interests, from sports and arts to academic clubs, volunteer work, and employment opportunities. Share with us these activities you have been a part of during your high school career.

DeleteExtracurricular Activities _ID_

Name of Activity

Position Held

Dates of Activities (MO/YR to MO/YR)

Click Here to Add Activity

Honors and Awards: Please list most recent first.

High school honors and awards recognize academic, artistic, athletic, and community service achievements. Examples include honor roll, AP Scholar awards, National Merit recognition, and participation in subject-specific honor societies. Students may also earn recognition for leadership, perfect attendance, and community service contributions. Share with us your honors and awards acknowledgment’s here.

Click Here to Add Honor or Award

Volunteer and Service Activities: Please list most recent first.

High school students have numerous opportunities to volunteer and engage in community service, benefiting both their community and themselves. These activities can range from helping at local shelters and food banks to tutoring younger students or participating in environmental cleanups. List the opportunities you have been involved with here.

DeleteVolunteer and Service Activities _ID_

Organization Name

Position Held

Dates of Service (MO/YR to MO/YR)

Hours of Service

Click Here to Add Volunteer or Service Activity

Work Experience: Please list most recent first.

High school work experience, including internships, part-time jobs, volunteer work, and job shadowing, offers students valuable opportunities to develop skills, explore career paths, and build a competitive edge for college and future careers. It provides practical experience, enhances career readiness, and fosters personal growth. Share with us any experience you have during your high school career.

DeleteWork Experience _ID_

Employer Name & Phone

Average Hours/Week

Dates Employed (MO/YR to MO/YR)

Job Title

Click Here to Add Work Experience

College/University Academic Information: Please list all schools attended and credits earned. Include CLEP and AP credits.

DeleteCollege/University Academic Information _ID_

College Name

Course Number & Name

Credits Earned

Grade Received

Click Here to Add College/University Academic Information

Documentation of Observation Hours: Show here you have completed and provide documentation of at least 10 hours of observation with a licensed physical therapist in one or more physical therapy settings. Observation of 20 hours is recommended. PTA, ATC, or OTD observations will not count towards these hours.

This document must be included with this application, demonstrating that you have completed at least 10 hours of observation with at least one licensed physical therapist.

Personal Essay

In your own words, write a personal essay describing your reasons for pursuing a career in physical therapy, and the personal characteristics you possess which will help you realize that goal. Please limit your response to approximately 4500 characters, including spaces.

Socioeconomic Indicators

Do you wish to be considered as a disadvantaged applicant that my consider such factors (economic, environment, educational) as part of their review process?

Yes

No

Wish Not To Respond

You grew up in a medically underserved area.

Yes

No

Wish Not To Respond

I am the first generation to enroll in Higher Education.

Yes

No

Wish Not To Respond

I am from a family that receives federal or state assistance (e.g., Aid to Families with Dependent Children, food stamps, Medicaid, public housing).

Yes

No

Wish Not To Respond

Certification

By typing your name below, you certify that you:

Have requested that an official copy of your high school transcript(s) be sent to the SAU Admissions office. Transcript(s) will document that: your cumulative high school GPA is at least 3.50 (on 4.0 scale).

Have completed one year each of high school chemistry and biology.

Uploaded documentation of Observation Hours form, demonstrating at least 10 hours of observation with at least one physical therapist. Hours with a PTA or ATC will not count.

By typing your name below, you certify that to the best of your knowledge, all information given on this application is correct and complete. You understand any material omission or misinformation may void your admission or result in dismissal. If this application is accepted, you agree to abide by the rules and regulations of St. Ambrose University as set forth in the catalog, student handbook, or other official documents of St. Ambrose University. This typed signature will hold as an official signature on this document.

Signature

Date