APPLICATION FOR ADMISSION
Office use ID #
School of Healthcare Administration and Leadership
Entry Term & Date:
 Master of Healthcare Administration (MHA)
 Fall 20_____
 Bachelor of Health Science Online Degree (BHS)
Concurrent Track Option:
 Master of Healthcare Administration/Healthcare Compliance Certificate
Graduate Certificates: Must complete a bachelors before applying
 Gerontology  Fall 20_____  Spring 20_____  Summer 20_____
 Healthcare Compliance (HCC)  Fall 20_____
Admission Status:
 First-year candidate: new applicant
 Re-Applicant
PERSONAL INFORMATION
Name: Last ___________________________________ First __________________________________ Middle ______________________
Other Name(s) used (if applicable): Last ___________________________ First ___________________________ Middle ________________
Social Security # ______-____-________ Date of birth (Month/day/year): ______/______/______ Email Address ___________________________
Are you a U.S. citizen?  Yes  No (If no, please see International Student Required Statements section below)
Current mailing address _______________________________________________________________________________________________
City ____________________________________________ State _______ Zip _______________ Country ____________________________
Phone: Home ____________________________ Work ______________________________ Cell ________________________________
Background Information: Answers to the following questions are OPTIONAL and are not used by Pacific University in making decisions.
Gender:  Male  Female  Other: _________________
Ethnic classification:
 Hispanic of any race
For non-Hispanics only:
 American Indian or Alaska Native  Asian  Black or African American  Native Hawaiian or other Pacific Islander
 White or Caucasian  Two or more races  Other
INTERNATIONAL STUDENT REQUIRED STATEMENTS
If not a citizen of the U.S., are you a Permanent Resident?  Yes  No
Visa Type: _______________________________________
Country of Citizenship: __________________________ Residence: _____________________________ Place of Birth: ________________
FEDERAL FINANCIAL ASSISTANCE: Do you plan to apply for federal financial aid?  Yes  No
If yes, submit the Free Application for Federal Student Aid (FAFSA) at www.fafsa.ed.gov to the federal processor as early as possible
after January 1 of each year. Checking “yes” will notify our Office of Financial Aid to look for your FAFSA data when it becomes
available from the federal processor. The Pacific University school code is 003212.
International applicants do not qualify for U.S. federal financial aid; therefore, do not need to file for FAFSA.
ESSAY
Essay: You are required to submit an essay to be considered for admission. The essay allows us to learn more about you and your
professional goals. In addition to the required essay, you may submit an optional statement if you believe there are special factors the
committee should consider in evaluating your application.
On a separate sheet of paper, please respond to the essay question that applies to your program of interest. Responses should be no
more than 2-3 page per question. Answer the questions for the following program(s) separately.
Essay Question: 1
Essay Question: 1
Essay Question: 1
Essay Question: 2
Essay Question: 1
| Master of Healthcare Administration and Leadership (MHA)
| Bachelor of Health Science degree completion (online) (BHS)
| Graduate Certificate Program in Healthcare Compliance (HCC)
| Graduate Certificate in Gerontology
| MHA/HCC – concurrent degree
Essay Questions:
1. Write an essay describing your professional goals and how the program relates to the achievement of those goals. Include in
your answer the decision making criteria, values and beliefs that influence those decisions.
2. What interests you about working in the field of gerontology?
3. Optional Statement – State any additional pertinent information you think we should know before evaluating your
application.
SCHOLARSHIP
SCHOLARSHIPS: Do you want to be considered for a scholarship?  Yes  No
Scholarships are available for a portion of each entering class. Recipients will be awarded one scholarship only.
Scholarship funds are limited, so you should complete your application early for optimal consideration.
EDUCATION
EDUCATION INFORMATION: List all colleges, universities, graduate schools, and professional schools you have attended and/or
currently attending. Request official transcript(s) from each institution listed below and have them sent directly to the Office of
Graduate Admissions. Attach a separate sheet if necessary.
Applicants whose college and/or university schooling took place outside the United States or Canada must have their transcript(s)
officially evaluated and translated into English. Contact the Office of Graduate Admissions if you need a list of evaluating services.
Institution
Dates attended
Major
Degree earned
Candidates for admission to the Masters of Healthcare Administration, Healthcare Compliance and Gerontology Graduate Certificate
program(s) must hold a bachelor degree from a regionally accredited college or university.
OTHER SCHOOLS
Please list any other institution, other than Pacific University, to which you intend to apply. Attach a separate sheet if necessary
_______________________________________________________________________________________________________
_
MISCELLANEOUS STATEMENTS
It is in your best interest to answer the following questions fully and to provide more information, rather than less. If you are uncertain
about how to answer these questions, please contact the Office of Admissions. Attach a separate sheet if necessary.
 Yes  No
 Yes  No
 Yes  No
Have you attended Pacific University before? If yes, when?
_________________________________________
Have you ever been dismissed from, suspended by, or subjected to disciplinary sanctions or reprimands
of any kind by any school, college, or university? If so, attach a detailed explanation on a separate sheet.
By signing this application, you release us to discuss this matter with the school involved should we feel
the need to do so.
How did you first hear of Pacific University? _____________________________________________
How did you first hear about the MHA/BHS/GERO/HCC (circle all that apply) _________________
Who or what influenced you to apply? ___________________________________________________
Have you served in the armed forces? If so, indicate location(s), name, branch, rank, date, and type of
discharge. Attach a separate sheet if necessary.
SIGNATURE
All essays and supplemental statements provided with this application are my own original work. To the best of my knowledge, the
information I have provided in this application is complete and accurate.
Prior to matriculation, I will notify Pacific University if there are any changes to the information I have provided. I also understand that
knowingly providing false information, or failing to provide critical information relevant to this application, may subject me to later
disciplinary action should I matriculate at Pacific University.
Signature ____________________________________________________________________ Date ______________________
APPLICATION REQUIREMENT CHECKLIST
 Application form: Complete and sign.
 Application fee: $50 USD (non-refundable) (Check payable to Pacific University)
 Admissions application fee waiver
 Resume: include work experience, internship, research, activities, community service and any honors/awards received
 Essay and any other additional statements
 Minimum GPA 2.75 for MHA, BHS & HCC
 Official transcript(s)
 Transcript evaluation (For international candidates only)
 Two official letters of recommendation (Not applicable for Gerontology candidates)
These letters will help the Admissions Committee evaluate your analytical and reasoning skills, academic competence, and
ethical character; determine your ability to relate to people and society; and assess your professional promise as a leader in
the field of healthcare management. Letters should be written by faculty and employers. Official letters may be submitted
electronically to gradadmissions@pacificu.edu or faxed to 503-352-7290.
 Test of English as a Foreign Language (TOEFL) educational testing score (For international candidates only)
Please mail all application requirements to:
Pacific University Office of Graduate and Professional Admissions
190 SE 8th Avenue, Ste. 181
Hillsboro, OR 97123
To apply online, visit https://www.applyweb.com/pumhaapp/. Any questions regarding status of your application or
admissions process, please contact the Office of Admissions at 503.352.7218 or email gradadmissions@pacificu.edu.
It is the policy of Pacific University not to discriminate on the basis of sex, disability, race, color, national origin, sexual orientation or age, in admission and access to, or treatment in employment,
educational programs or activities as required by Title IX of the Education Amendments of l972, section 504 of the Rehabilitation Act of l973, Title VII of the Civil Rights act of l964, the Age
Discrimination in Employment Act, the Americans With Disabilities Act of l990 and their implementing regulations.
Students are expected to adhere to the university non-discrimination policy and to the Social Work Code of Ethics in regard to non-discrimination.