PTA Program Application

Refer to the Physical Therapy Program Website, How to Apply Tab, Application Checklist to make sure you complete the application process thoroughly and accurately. Applicants who submit incomplete applications or who are missing any required documents will automatically be ineligible.

Your application must be completed within 2 hours. You will not be able to save and return to make any changes or submit at a later time. Only one application submission per application cycle is allowed.

Do you have a Social Security #?
Have you ever attended another Physical Therapist Assistant Program or any program which included placement in a clinical facility?
Did you complete that program?
If no, are you eligible to return to that program?
Are you a U.S. citizen?
If no, are you in the U.S. as a Permanent Resident?
If no, are you in the U.S. on a Visa?
Are you lawfully eligible to work in the U.S.?
 Check all that apply
Must attach copy of high school transcript, OR copy of diploma, OR copy of GED certificate. If from foreign country, must provide translation.
Previously applied to any health profession program at College of the Canyons?
Previously completed the ATI TEAS - Version 7 (effective June 2022)

List All Colleges Attended (include College of the Canyons, universities/military, USA/foreign; failure to list all colleges attended will result in ineligibility.)

Name of College Degree Earned Weight
more items
To list all college attended, use + and – to add or delete colleges.  One college per line.

 

Multicriteria Screening

Check all that apply:

Education/Experience
list below; however, if you are submitting Physical Therapist Assistant Program Employer Verification Of Work Experience Form, do not list the same work experience in this section.
Employment
(must attach complete Physical Therapist Assistant Program Employer Verification Of Work Experience Form at end of application in file uploads as .pdf file only).
Life Experience
(The same meaning as used in Section 2626 of the Unemployment Insurance Code)
(Measured in terms of a student's eligibility for, or receipt of, financial aid under a program that may include, but is not necessarily limited to, a fee waiver from the Board of Governors, The Cal Grant Program, the federal Pell Grant program or CalWORKS)
(The student is working at least part time while completing academic work that is a prerequisite for admission to the PTA program)
(Includes, but is not limited to, the status of a student who has participated in EOPS)
Language Proficiency

Demographic Information

This information is confidential and is gathered for statistical purposes only. The information provided below, or the failure to provide the information below, will in no way affect your ability to enter the Physical Therapist Assistant program.

Gender
Ethnicity
(All persons having origins in Europe, North Africa or the Middle East and not of Hispanic origin)
(All persons of Chicano, Mexican, Puerto Rican, Cuban, Central/South American, or other Spanish culture origin regardless of race)
(All persons having origins in the original peoples of North America and who maintain cultural identification by virtue of tribal association or community recognition)
(All persons having origins in the Far East, Southeast Asia, the Indian Subcontinent, or Pacific Islands, including the Philippine Islands)
(All persons having origins in any of the black racial groups of Africa and not Hispanic in origin)
Education
Highest level of education obtained to date

Persons with Disabilities

It is your responsibility to notify the Disabled Students Programs and Services office at the College with verified documentation from a health or learning specialist in order to receive reasonable accommodation.

Non Discrimination Policy

The School of Health Professions does not discriminate on the basis of ethnic group identity, religion, sex, age, color, national origin, marital status, sexual orientation, veteran's status, mental disability or physical disability including persons with AIDS/ARC/HIV in any of its policies, procedures, or practices. This non-discrimination statement covers admission and access to, and treatment and employment in the programs, services and activities.

File Uploads

Please attach the applicable documents needed to complete your Physical Therapist Assistant Application as .pdf files ONLY

  • If you checked the box indicating no college degree posted, you must attach copy of high school transcript, OR copy of diploma, OR copy of GED certificate. If from foreign country, you must provide translation from an official agency.

 

  • If you checked Employment Experience, you must attach complete Physical Therapist Assistant Program Employer Verification Of Work Form.

 

  • Technical Standards (completed form) must be attached.
Maximum 10 files.
15 MB limit.
Allowed types: pdf.