MPAS Early Admission Application

Applicant Demographics

Applicants must first complete a separate St. Ambrose University undergraduate application for admission.

First Name

Last Name

Preferred Name

Gender

Female

Male

Prefer not to say

Birthdate

Place of Birth (City, State)

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone

I authorize St. Ambrose University and it's representatives to contact me via text message. By checking Yes, I am giving my consent. I understand that message and data rates may apply and that I can opt out at any time.

Yes

No

Email Address

United States Citizen?

Yes

No

If no: Citizenship Status?

Non-Resident International Student

Resident International Student (Permanent/Green Card Holder)

DACA/DREAM Student (Undocumented)

Anticipated start term for MPAS

How did you hear about the SAU MPAS program?

Compliance Data on Ethnicity and Race

The following questions are asked in compliance with the Department of Education federal guideline requirements to collect data on ethnicity and race. This information is confidential and does not affect admission.

Ethnicity

Hispanic/Latino

Non Hispanic/Latino

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Socioeconomic Indicators

Answer the following questions to the best of your knowledge.

My family is considered economically disadvantaged based on income.

Yes

No

Don't wish to respond

I am the first generation to enroll in higher education.

Yes

No

I dropped out of high school and earned my AHS diploma or GED or I am receiving public assistance.

Yes

No

Don't wish to respond

I am from a family that receives public assistance (e.g. aid to families with children, food stamps, Medicaid, public housing)

Yes

No

Don't wish to respond

English isn't my primary language.

Yes

No

Don't wish to respond

Which geographic area best describes the town/city in which you were raised?

Academic and School Involvement

List all high schools attended, listing the most recent first.

Please enter your most recent high school attended/graduating from.

High School City

High School State

Start Month

Start Year

Attended to Month

Attended to Year

High School Graduation Date

Current High School Cumulative GPA

ACT and/or SAT Score(s)

Class Rank

List all college and university credits earned, including CLEP and/or Advanced Placement (AP) credits.
Example: Hawkeye Comm. College, Introductory Biology, 4 credits

High School Science Courses

List the high school courses you completed in Biology, Chemistry, and Physics.

For each course, also list the YEAR it was taken and the GRADE you earned.

Biology Courses
Example: Biology, 9th grade, B

Chemistry Courses
Example: Biology, 9th grade, B

Physics Courses
Example: Biology, 9th grade, B

Extracurricular Activities

List the most recent first, as well as the role you had in each activity, and the year(s) in school you participated.

Extracurricular Activities
Example: Student Government, Vice President, 11th grade

Honors and Awards

Work and Volunteer Experience

List the most recent experience first.

Work Experience

List position, employer, avg. hours/week, and when you worked there.
Example: Clerk, Hy-Vee, 20hrs/week, 2018-2020

Volunteer and Service Experience

List the organization, your position (if applicable), approximate hours you volunteered, and duration.
Example: Habitat for Humanity, 56 hours, 2017-2019

Shadow Experience

List the organization, your position, hours spent shadowing, and duration.
Example: Allen Hospital, 40 hours, 2019-2020

Personal Goals Statement

In a separate, typed document, use your own words to write a personal essay describing your reasons for pursuing a career as a Physician Assistant.

Additionally, share the personal characteristics you possess that will help you realize that goal.

Limit your response to nor more than 4,500 characters (including spaces).

Submitting Your Essay

I will attach my essay to this application

I will send my essay in via postal mail

Attach your Essay

Documentation and Enclosures Checklist

Request transcripts be mailed to:

St. Ambrose University, Office of Admissions, 518 W. Locust St., Davenport, IA 52803

Send Personal Goals Statement to St. Ambrose University, MPAS Program, 1320 W. Lombard St., Davenport, IA 52804

Check All That Apply

I have requested an official copy of my high school transcript(s) be sent to SAU Admissions.

I am enclosing or have previously mailed an official copy of my ACT and/or SAT scores.

Certification

Indicate below your agreement to these statements:

I certify that to the best of my knowledge that all information on this application is correct and complete. I understand any material omission or misinformation may void my admission or result in dismissal.

If this application is accepted, I 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.

I agree