Allied Health Application - PTA (v2)

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ALLIED HEALTH APPLICATION FORM - PTA

New to CCAC? Please click HERE to complete an Admissions Application and create a CCAC account.

You will then be assigned a unique student ID number.

CCAC Student ID:*

This number is specific to CCAC. Applicant must be registered with the college to receive.

First Name*

Last Name*

Email Address:*

Confirm Email Address: *

Phone:

Use the following format: xxx-xxx-xxxx

Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

APPLICATION FOR:

Semester:

Fall Spring

Year

DEMOGRAPHIC INFORMATION (For Statistical Purposes Only; Not Used to Determine Admission)

Date of Birth:*

Gender*

Residency Status*

Allegheny County Out-of-County Out-of-State

County Name:*

State if Out-of-State resident:*

Ethnicity*

Race*

EDUCATIONAL INFORMATION

Student Status:*

Current CCAC Student Previous CCAC Student Previous Student/Other College

CCAC Campus currently attending:*

CCAC Campus previously attended:*

How many previous institutions have you attended?*

Name of School:*

Name of Program:*

Years Attended:*

Degree or Diploma:*

Name of School: *

Name of Program: *

Years Attended:*

Degree or Diploma:*

Name of School: *

Name of Program: *

Years Attended: *

Degree or Diploma: *

Name of School: *

Name of Program: *

Years Attended: *

Degree or Diploma:*

Highest Level of Education Attempted:*

Major*

Associates Degree

Major*

Bachelors Degree

Major*

Masters Degree

Major*

Doctorate

Other:*

High School Graduation Year:*

High School Name:*

City & State*

High School

Have you taken a science course within the last 10 years?*

Science courses taken in last 10 years: - Copy*

Biology with Lab Physics Chemistry Anatomy & Physiology

PROGRAM INFORMATION

CCAC Allied Health Programs are only available at select campuses. The PTA program is located at Boyce Campus.

Visit the PTA program website if you have any additional questions or wish to contact the program's coordinator.

PTA Program Requirements

NOTE: Some ALH programs require additional documentation to be submitted during the application process. If your application does not include all program-specific paperwork it will be considered INCOMPLETE and will not be processed.

Please visit the Physical Therapy Assistant program page to confirm admission requirements.

Attachments for PTA Program Application:

Submit a copy of your unofficial transcript.  Refer to the 'Transcripts' section of this application.
Submit your Self Essay

In addition, please complete the listed items provided at the following Docusign(s) Link:

TAS Sheet
Essential Functions
Pre-Requisites Checklist
ALH Application Validation Form

PTA Docusign

Also, please complete the following at the link below:

Clinical Observation Form
- All information can be completed via DocuSign for applicant and facility.
- Enter the Physical Therapist or Physical Therapist Assistant Name and email address to allow completion of Observation/Employment hours.

Clinical Observation Form

Please attach your Self Essay.

Self Essay

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Allied Health Program Essential Functions Requirements

Please visit the Nursing & Allied Health program page to confirm the Essential Function requirements for the program of choice.

Note that some programs require the submission of a completed Essential Functions Form for the application process.

Please complete the document below.

I have read and agree that I can comply with the Allied Health Programs Essential Functions.*

Yes No

Transcripts

A copy of Official Transcripts from previous colleges or universities attended MUST be submitted to CCAC for evaluation following the guidelines on the Transfer of Credits website. Upon receipt of your official transcripts, your transcript will be evaluated and you will receive a Transfer Summary from the Registration Department. Some programs request that a copy of Unofficial transcripts be submitted as an attachment to this application using the attachment upload link provided. Please read the requirements of your selected program carefully.

Please attach a copy of your UNOFFICIAL Transcripts*

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Please submit all as ONE attachment.

Will you be submitting a Transfer of Credits evaluation request?*

Yes No

Have you received confirmation of your Transfer of Credits evaluation?*

Yes No

Please contact Transcripts@ccac.edu to obtain a copy of your confirmation

If you have questions regarding the status of your Transfer or Credits evaluation.

Please attach the following:

Transfer of Credits Evaluation

Transfer of Credits Evaluation*

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