UNIVERSITY OF DELAWARE
PHYSICAL THERAPY DEPARTMENT DPT PROGRAM
APPLICATION FOR EARLY DECISION
UNIVERSITY OF DELAWARE UNDERGRADUATES
DEADLINE JUNE 1, 2012
Name:
Student Number:
Mailing Address:
Telephone:
E-mail:
I.
Education:
College/University
Major
Years attended
Degree(s) or date
expected
II.
Physical Therapy Related Work/Volunteer Experience:*
Facility
Dates
Job Description
Supervisor/Title
Approximate #
of total hours in
this job
* provide documentation (i.e., letters from physical therapy departments
Director/supervisor) signed by supervisor with supervisor’s title.
III.
Letters of Reference
Three letters of reference are required. It is your responsibility to have these references
sent to the department along with your application. Please include everything in one
packet. It is required that two letters be submitted from a Physical Therapist who can
address the clinical experiences and abilities of the applicant and one letter be submitted
by an instructor of an upper level course taken at the University of Delaware.
Name
Title
Address
Phone #
IV. The DPT program has a number of required courses that must be completed prior to
beginning the program. Identify the name and course number, credits, institution where
you completed the course, the semester or quarter credits, (identify if they are semester or
quarter credits), the grade achieved, and the year you took the course. (If you have not
completed a course, indicate how you plan to complete it before you begin the program in
July.)
Prerequisite
Course Name
Credits
Institution
Grade
Semester/Yr.
Calculus (3)
Biology I with
lab (4)
Biology II with
lab (4)
Physiology (3)
Physics I with
lab (4)
Physics II with
lab (4)
Chemistry I
with lab (4)
Chemistry II
with lab (4)
Statistics (3)
English (3)
Introductory
Psychology (3)
Advanced
Psychology (3)
V.
On the following page, write a short essay on the following statement.
Autonomous practice is a goal of the American Physical Therapy Association. What
does autonomous physical therapy practice mean to you and what characteristics do
you display that would allow you to contribute to this practice goal?
Please answer the following question:
Have you ever been charged or convicted of a crime? If yes, please explain.
I hereby certify that I have made no willful misrepresentations nor have I withheld information
pertinent to this application. I understand that the information given by me in this application
will be investigated (transcripts, references, etc.).
Signature of Applicant
_____________
Date
Reminder! Please include letters of reference and documentation of hours with
application and deliver to Admissions at 301 McKinly Lab