Physical Therapist Assistant Program Application * Your Name * Your VCCS ID * Street Address * City * State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon * ZIP * Phone * Your VCCS Email I attended a Germanna PTA Program information session in: Month Make selection here...JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year Make selection here...20192020202120222023 I completed the following Volunteer or Observations Hours: Inpatient (not required) Yes No Outpatient (required) Yes No Please review the following document. ESSENTIAL FUNCTIONS FOR THE PHYSICAL THERAPIST ASSISTANT STUDENT I acknowledge that I have received and reviewed the above Essential Functions of the PTA student, and understand that I am expected to meet these requirements. 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. Upload Personal Statement essay here (Microsoft Word documents only) One file only.100 MB limit.Allowed types: doc, docx. I certify that I am the author of this essay. Sign above CAPTCHA What code is in the image? Enter the characters shown in the image. Leave this field blank
