Physical Therapist Assistant Program Application

Please choose one:*

First Application

Second

Third

Are you a Transfer Student?*

Yes

No

If Yes Please Enter the Name of School you are Transferring from:

Did you Submit your Official Transcripts to the KCC Transfer Office? (Required for official course credit)

Yes

No

You must email your official transcript to the KCC Transfer Office

First Name:*

Last Name:*

Middle Name:

Have KCC ID?

Yes

No

Enter KCC ID Number:

Email:

Address:

US citizenship, Permanent residency or International Student w/F-1 visa:

Yes

No

Home phone:

Cell phone:

Course requirements (Eng12, Mat20, Bio11, and Psy11) are required prerequisites for entry into the PTA program.

Overall GPA:

English 12

Yes

No

Grade?*Grade required information for All Courses. If you do not have a grade please write N/A,if enrolled in Fall Semester write Fall

Math20

Yes

No

Grade?*Grade required information for All Courses. If you do not have a grade please write N/A,if enrolled in Fall Semester write Fall

PSY1100

Yes

No

Grade?*Grade required information for All Courses. If you do not have a grade please write N/A,if enrolled in Fall Semester write Fall

Bio11

Yes

No

Grade?*Grade required information for All Courses. If you do not have a grade please write N/A,if enrolled in Fall Semester write Fall

You must email

Letter verifying completion of Volunteer hours.(Minimum 25 Hours)
Letter of Recommendation from a Physical Therapist or a Physical Therapist Assistant.
Essay 500-1000 words. Essay question: There are many health care related careers, why do you want to become a PTA?
Email to: PTA_Program.KCC@kbcc.cuny.edu by November 15,2022 @11:59pm

Please check your highest level of Education:

HS

Associates

Bachelors

Masters

Diploma/Certificate

Name of school you received your previous education/degree?

Year Obtained?

In what subject was your previous Academic Certificate/Degree?

Please enter any additional comments related to your application:

For further information, you may email the Physical Therapist Assistant Program Director, Dr. Michael Mattia, at Michael.Mattia@kbcc.cuny.edu
Or call 718-368-4818

I certify that the attached application related items are correct and accurate. I understand that the falsification of any information or documentation will result in the revocation of this application.

I certify

I don't certify

Pick date of application submitted:

Kingsborough Community College | Dreams Begin Here

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PTA Application

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