Physical Therapist Assistant Program Application

Your Name *

Your VCCS ID *

Street Address *

City *

State *

ZIP *

Phone *

Your VCCS Email *

Campus Selection *

I am a veteran planning on using VA benefits.*

Yes

I attended a Germanna PTA Program information session in:

Month

Year

I have completed the following Volunteer or Observation hours and submitted the form to ptassistant@germanna.edu:

Inpatient (not required)

Yes

Outpatient (required)

Yes

Please review the Essential Functions for the Physical Therapist Assistant Student document.

I acknowledge that I have received and reviewed the above Essential Functions of the PTA Student, and understand that I am expected to meet all requirements with the exception of those noted on the attached documentation of accommodations, as agreed to by the PTA Department Program Director.

Personal Statement essay (600-1000 words) *

I certify that I am the author of this essay.

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Physical Therapist Assistant Program Application

Physical Therapist Assistant Program Application