PA Supplemental Application – Atlanta Campus

Please send all transcripts directly to CASPA. GRE scores are sent directly to South College (code:4173).

In order to officially apply to the program, please complete your application with CASPA at : http://www.caspaonline.org

You must have a CASPA ID prior to completing this Supplemental Application.

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) has granted Accreditation-Continued status to the South College Masters of Health Science Physician Assistant Program sponsored by South College. Accreditation-Continued is an accreditation status granted when a currently accredited program is in compliance with the ARC-PA Standards. Accreditation remains in effect until the program closes or withdraws from the accreditation process or until accreditation is withdrawn for failure to comply with the Standards. The approximate date for the next validation review of the program by the ARC-PA will be September 2027. The review date is contingent upon continued compliance with the Accreditation Standards and ARC-PA policy.

The South College Physician Assistant Program in Knoxville, Tennessee is in the process of seeking approval from the ARC-PA for an extension campus in Atlanta, Georgia. The ARC-PA will make a determination about the extension request during the June 2019 agenda meeting. If approved, the anticipated start date for the South College campus in Atlanta, Georgia will be October 1, 2019. If the ARC-PA does not approve the extension to the Atlanta campus, students who were offered a seat at the Atlanta campus and paid the $1,500 seat deposit will receive a refund of the seat deposit. There is a rolling admissions process for each campus, Knoxville campus and the Atlanta campus, in which seats for each class are offered at a designated campus from November through May. if the Atlanta campus is not approved by ARC-PA, students offered a seat in Atlanta will not be granted a seat in the Knoxville Program.

South College
School of Physician Assistant Studies
ATTN: PA ADMISSIONS
2600 Century Parkway NE Atlanta, GA 30345

CASPA ID:*
Name:*
Under what other name(s) might documents be received?
Age:*
Date of Birth:*
Place of Birth:*
Race:*
Social Security Number:*
Sex:*

*INFORMATION NEEDED FOR STATISTICAL REPORTING TO THE U.S. DEPT. OF EDUCATION.

Telephone number at which you can be reached between 8:00am and 5:00pm:
-
Home Phone:
-
Cell Phone:
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E-mail:
Permanent Address:
Temporary Address:
Preferred mailing address:
County and state of legal residence:
Employed by:
Occupation:
Business Phone:
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Emergency Contact Name:
Relationship:
Emergency Contact Address:
Emergency Contact Phone:
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Are you a United States Citizen?
In No, indicate Legal Status:
Have you previously applied for admission to South College?
If Yes, when?
School or Program:
How did you learn about the Physician Assistant Program?
EDUCATION
Undergraduate Degree (List all cities, states with dates of schools and universities attended)
#1 College Name:
#1 College Address:
#1 Date of degree (if any):
#1 Dates of attendance:
#2 College Name:
#2 College Address:
#2 Date of degree (if any):
#2 Dates of attendance:
#3 College Name:
#3 College Address:
#3 Date of degree (if any):
#3 Dates of attendance:
Year of graduation:
Major:
Minor:
Graduate Degree (if applicable)
#4 College Name:
#4 College Address:
#4 Date of degree (if any):
#4 Dates of attendance:
#5 College Name:
#5 College Address:
#5 Date of degree (if any):
#5 Dates of attendance:
Year graduate degree earned:
Major (graduate):
Prerequisite Courses
Have you completed all prerequisite courses (as listed on the SCPA website)?
GRE Test Information
Have you taken the GRE?
If Yes, when:
Results - verbal:
Results - quantitative:
Results - Analytical Writing Sample:
If No, when do you plan to do so?
DO YOU WISH TO APPLY FOR FINANCIAL AID?
Medical Military Experience
Branch of military:
Number of years of active duty:
Date of entrance:
Date of discharge:
Type of discharge:
If you are now on active duty, what is the earliest date you would be available to enter the program?
Were/are you a corpsman or medic in the service?
IDC:
18-D:
Will you be attending under the GI Bill?
FERPA RELEASE

South College provides for the confidentiality of student records in accordance with the Family Educational Rights and Privacy Act (FERPA), as amended. I understand that in order to consider my application to the School of Physician Assistant Studies, the Office of Admissions will release my student records as necessary to members of the School of Physician Assistant Admissions Committee, employees of South College and others who have a need to access my student records in order to process my application for admission.

RELEASE

I hereby release South College and any firm with which South College may contract, from any debts, claims, actions, causes of action, demands, suits, and all liabilities whatsoever both in law and in equity, which may result from participation in any telecast or still photography made by or produced by South College.

In doing so, I hereby grant South College the right to use my name, photograph, likeness, or voice in any production connected with the College.

 I hereby represent and warrant that I am of full age and have every right to contract in my own name in the above regard. I further state that I have read the above authorization and release prior to its execution and that I am fully familiar with the contents thereof.

I certify that all statements made in this supplemental application are complete and true and understand that every student enrolling at South College agrees to abide by all policies and regulations of the College that may be found in the Student Handbook or in the College Catalog or other official publication. I understand and agree that any misrepresentation of facts on this supplemental application is just cause for refusal of admission or dismissal from South College.

As acceptance of this registration, please type your full name below.

Applicant Signature:*

By entering your name, the last four digits of your social security number, and submitting the document, you electronically agree and confirm your understanding of the items, as outlined, in the above document.

Last four of social:*
Word Verification: