PA Supplemental Application

If you see this don't fill out this input box.

CASPA Number*

Enter your CASPA Application number

Social Security Number*

Enter your Social Security Number here

SECTION I

Provide your personal information below.

First Name*

Middle Name

Last Name*

Address*

Enter your mailing address

City*

State*

Zip*

Phone*

Enter the best phone number to contact you

E-mail*

SECTION II

Provide supplemental personal information below.

What languages do you speak other than English?

Have you previously applied to any graduate programs at K-State?*

Yes

If so, what programs have you made application?

If you have applied to other programs, in what year(s) did you apply?

How did you learn about the K-State PA program?*

SECTION III

Parent's Name

Parent's Occupation

Parent's Employer

Parent's State of Reisdence

Is this parent living or deceased?

Living

Deceased

Parent's Name

Parent's Occupation

Parent's Employer

Parent's State of Residence

Is this parent living or deceased?

Living

Deceased

Spouse/Significant Other's Name

Spouse/SO Occupation

Spouse/SO Employer

Spouse/SO State of Residence

Is your spouse/significant other living or deceased?

Living

Deceased

SECTION IV

Military Service / Relationship

Please describe your own, or the service of a related parent, or spouse/partner in the military below.

Note: If you currently or have previously served in any of the indicated branches, AND are the spouse/partner or child of a currently or formerly serving military member please answer using your own service.

Current status:

Active Duty Member

Former Active Duty Member

Service:

Military

National Guard

Military Reserves

If not active duty yourself, I am:

Spouse/partner of an Active Duty Member

Child of an Active Duty Member

Child of a Former Active Duty Member

I choose not to disclose this information

If you have served in the military, list Branch of Service:

Number of years of active duty:

Date of entrance:

Discharge date:

Type of discharge:

If you are still serving, what is the earliest date you will be available for the K-State PA Program?

Please describe your principle duties in the military:

Were/are you a corpsman or medic in the service?

Yes

IDC?

18-D?

Will you be attending under the GI Bill?

Yes

SECTION V

Please provide your K-State Specific narrative statement. Please write a concise narrative stating your reason(s) for wanting to attend the K-State PA Program. This is your opportunity to tell the Admissions committee why you deserve serious consideration for a seat in the next class. This should NOT be a duplication of your CASPA narrative. Do not cut and paste your CASPA narrative.

Specifically, tell us:

How have your activities and life choices prepared you to become a K-State PA?*

What do you bring to the K-Sate PA Program that will help the Program meet its mission?*

What does the K-State PA Program offer you?*

SECTION VI

Have you completed all prerequisite courses (as listed on the website)?*

Yes

If you are currently completing any coursework, please list here:

Have you considered, or been trained in another health care profession?*

Yes

If yes, what factors influenced your decision to pursue the PA profession versus your initial choice?

If no, what attracted you to the PA profession?

SECTION VII

Community Service
Please list all hours even if you listed them in CASPA.

Include for each organization: the organization name, location, your role, the number of hours you participated, and your duties*

SECTION VIII

List and describe any positions of leadership you have held:*

SECTION IX

List any awards or honors you have received:*

SECTION X

CERTIFICATION

I certify that all statements made in this supplemental application are complete and true, and understand that every student enrolling at Kansas State University agrees to abide by all policies and regulations of the University that may be found in the Graduate Handbook or in the University Policy & Procedures Manual, or other official publication. I understand and agree that any misrepresentation of facts on this supplemental application is just cause for refusal of admission or dismissal from Kansas State University.

As acceptance of this registration, please type your full name below.

(Name that appears below is deemed an electronic signature)

Signed:*

Enter your full name as an electronic signature

Date:*

Supplemental Application

PA Program Supplemental Application