Division of Health
Physical Therapist Assistant Program
Program Application
2016
The Physical Therapist Assistant Program at Calhoun Community College is accredited by the Commission on
Accreditation in Physical Therapy Education (CAPTE), 1111 North Fairfax Street, Alexandria, Virginia 22314;
telephone: 703-706-3245; email: accreditation@apta.org; website: www.capteonline.org.
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Physical Therapist Assistant Program
2016 Application Process
You are strongly advised to carefully read application instructions
and other information available on the PTA program website under
Frequently Asked Questions at www.calhoun.edu
If you have a question about the application process, please verify that it has not been answered in
the FAQ section of the website prior to contacting the Allied Health Department.
If not already completed, at least one month before you apply to the PTA Program, submit a Calhoun
Community College Application for Admission and request that transcripts from previously attended
institutions are forwarded to CCC.
Applicants to the PTA program must minimally:
□ Meet all admission requirements of Calhoun Community College
□ Submit a completed 2016 PTA Program Application packet which includes:
o A CCC transcript documenting all previously completed general education
coursework taken at Calhoun or accepted in transfer
o An ACT reading score or COMPASS reading assessment placement score
from the past 3 years
o Documentation of 24 hours of physical therapy observation signed by
licensed PT personnel
o An essay discussing your physical therapy observation experiences
o Two (2) letters of professional recommendation in the requested format
Meeting minimal requirements does not guarantee acceptance. The number of students selected for
admission to the PTA program is limited and therefore the application process is competitive. All
applications are evaluated by the PTA Admissions Committee and assigned a score based on the
point system described within. Points are awarded on the basis of the information included in the
application packet. The top scoring applicants are offered an opportunity to enroll.
All application documents must be received in ONE ENVELOPE by the Allied Health Secretary no later
than Thursday, April 14th 2016 at 3:00 PM to be considered for the next PTA class beginning fall
semester 2016. Application packets can be mailed or delivered in person but must be received by the
deadline date and time. Information cannot be accepted via fax or by email. Applications will not be
accepted past the deadline.
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Physical Therapist Assistant Program
PTA APPLICATION POINT SYSTEM
1. Points are earned for successful completion of the general education courses required for the
AAS degree in PTA. The number of points is determined by the grade earned.
PLEASE READ THE FOLLOWING PARAGRAPH CAREFULLY: ALL applicants must submit
an unofficial copy of a Calhoun Community College transcript in the original
application packet which includes all coursework taken at CCC and coursework
applicable to the PTA degree requirements taken at other colleges and accepted in
transfer. The Admissions Office should be contacted with questions regarding the
transfer of credit. Do not submit transcripts from other colleges with the PTA
Application. Coursework taken at other educational institutions must be evaluated
and accepted by the CCC department of Admissions and Records to be considered. It
is the applicant’s responsibility to make certain all relevant coursework is listed on
the CCC transcript. Applicants must highlight courses & grades being claimed for
points on the CCC transcript.
Points for general education courses taken spring semester 2016 will be added to the
application academic score if an unofficial transcript of course completion with the
grade earned is submitted to the Allied Health Secretary. (If you are attending another
College, please read the FAQ re: the submission of spring grades.) This is the
responsibility of the applicant and the documentation must be received no later than
3:00 PM on Tuesday, May 17th, 2016.
2. Points are earned based on an ACT reading or COMPASS reading assessment score from the
past three years. The submission of an ACT or COMPASS reading score is required of all
applicants regardless of the score or prior educational accomplishment. Points are assigned
according to the grid on page 9.
3. Points may be earned by attending ONE PTA Program Information Session in the fall of 2015
or spring of 2016. Dates, times and location of information sessions are posted on the PTA
website.
4. Points are earned by completing and correctly documenting 24 hours of physical therapy
observation. See page 7 for instructions.
5. Points are awarded for an essay which discusses your physical therapy observation experiences.
The essay should be type written, 2-3 pages in length with standard spacing, margins and a
standard font.
6. Points are awarded based on two (2) professional recommendations using the attached form and
submitted as instructed – see pp. 16-17 for directions.
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CCC PTA APPLICATION POINT SYSTEM
ACADEMIC POINTS
1. General education
courses
2. ACT / COMPASS
reading score
NOTES:
65 points possible →No points will be awarded if courses & grades are not listed on an
enclosed unofficial transcript issued from the CCC Admissions Office
→A copy from MYCALHOUN is “OK”
→Highlight the completed courses & grades on the CCC transcript that
you are claiming for application points on the gen. ed. worksheet
→Applicants may select any MTH course to use for points on the
gen. ed. worksheet as long as it is MTH 100 or a “higher” MTH course.
MTH 265 is NOT a “higher” MTH.
→ENG 101 is the ONLY course & grade that may be used for English
points
→See list of courses that qualify as HUM requirement – applicant may
select course to use for points
→ Remember to submit grades from spring 2016 semester classes
no later than 3PM on 05/17/2016
→ See general education worksheet page 8
10 points possible →An application is incomplete if submitted without an ACT/COMPASS
reading test, regardless of the score!
→ No points will be awarded if ACT or COMPASS taken prior to 2013
→ See page 9
PROFESSIONAL POINTS
3.Information session
5 points possible
4. Observation hours
5 points possible
5. Essay
7.5 points
possible
6.Professional
recommendations
7.5 points
HELPS:
→ Attend a Fall 2015 or Spring 2016 info session
→ Legibly print and sign your name on the attendance roster at the
info session
→ Be punctual
→ If you live out of the area or have other hindrances to attending an
info session, please contact the PTA program
→ Follow instructions on the documentation form page 7
→ Complete the required number of inpatient & outpatient hours
& clearly differentiate them
→ Experiences must be signed by a licensed PT or PTA
→ Make certain documentation is legible & hours can be
verified
→ Observation hours should be within past 3 years
→ Additional hours may be personally beneficial but will not
accrue additional points
→ Type written, standard margins, spacing, & standard font
→ 2-3 pages in length
→ Discuss your observation experiences & what you learned
→ Use the required form pages 16-17
→ Follow directions regarding sealing
→ The best professional references are employers, teachers,
and others who are able to rate you on the 6 attributes
noted on the recommendation form
→Additional references &/or letters do not accrue extra points
100 points
possible
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Physical Therapist Assistant program
Application Envelope Checklist
To be considered complete, an application packet must include the ALL of the following
documentation:
□
PTA Application Personal Information sheet, page 6.
□
PTA Application General Education Course Worksheet page 8, noting general
education courses previously completed and the grade received.
□
PTA Application Points Worksheet page 9, noting your ACT / COMPASS reading
score and date of attendance of a PTA Information Session.
□
PTA Application PT Observation Documentation Form page 7, indicating a
minimum of 24 hours of physical therapy observation with twelve (12) hours
observation in an inpatient setting and twelve (12) hours in an outpatient
setting.
□
A 2-3 page typed essay discussing your physical therapy observation experiences.
□
A copy of an ACT Reading Score or COMPASS Reading Placement Test score
report from the past three years.
□
An unofficial copy of a Calhoun Community College transcript which includes all
coursework taken at CCC and coursework taken at other colleges and accepted
in transfer
□
Two sealed letters of Professional Recommendation, pages 16-17.
□
PTA Program Statements of Understanding pages 10-15, dated and signed.
Documentation must be complete, legible, and all aforementioned forms must be included in the
application packet. Applications missing the required documentation will not be considered.
PLEASE DO NOT STAPLE FORMS OR OTHER DOCUMENTATION.
Each time an individual applies to the PTA program an application packet must be completed in its’
entirety; copies of items submitted should be retained as information will not be released from
previous application packets.
The PTA Admissions Committee meets in late May. All applicants will be notified by mail of admission
status into the PTA program in early June. Letters will be mailed to the address provided by the
applicant.
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Physical Therapist Assistant Program
Personal Information Sheet
Applications to begin PTA Fall 2016 must be received by 3:00 PM on April 14th, 2016. An application
packet may be mailed or delivered in person to the Allied Health Secretary on the third floor of the
Health Sciences Center, Decatur campus. All applicants receive notification regarding selection for
the program.
Name _________________________________________
_________________________________________________
Last
First
MI
Mailing
Address__________________________________________ City_____________________________________________
Home Phone____________________________________
State_______________________ Zip__________________
Cell Phone______________________________________
Email___________________________________________
Work Phone_____________________________________
Emergency Contact :
Name__________________________________________
Relationship:______________________________________
Phone_________________________________________
List all colleges and/or universities you have attended and any degrees received:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Mailing address: Calhoun Community College
Health Sciences Center
ATTN: Allied Health Secretary
P.O. Box 2216
Decatur, AL 35609
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Physical Therapist Assistant Program
Name of Applicant ____________________________________________________________
Physical Therapy Observation Documentation Form
Applicants should complete a minimum of 24 quality hours of observation - twelve (12) hours in an inpatient facility (hospital or nursing home) and twelve (12) hours
in an outpatient clinic. Home health hours are not accepted. Experiences must have been within the past three (3) years. Credit should only be given for actual time
spent observing patient care. Individuals working as paid employees in a PT department may use their regular work hours to complete this requirement. See FAQ for
questions re: observation hours. Hours will only be accepted if signed (no electronic signatures) by a licensed PT or PTA. Properly documented observation hours will
be accepted on forms from other educational institutions.
Date
Example:
08/21/15
Starting
Time
Ending
Time
HR:MIN AM/PM
HR:MIN AM/PM
8:00 AM
11:30 AM
# of
Hours
Name of Facility
Location
(City, State)
Telephone
Number
Inpatient or
Outpatient?
Signature of Supervising
PT or LPTA
3.5
Robust Physical
Therapy
Huntsville, AL
xxx-xxx-xxxx
outpatient
John Doe, LPTA
1.
2.
3.
4.
5.
_________TOTAL DAYS
_________TOTAL HOURS
(This form may be reproduced as necessary to document hours of observation)
I certify that the hours listed above were fulfilled by me. I understand that the PTA Admission Committee may verify this document for authenticity and I realize that
falsification of information will result in my application to the PTA Program being withdrawn from consideration.
_________________________________________________
Applicant Signature
____________________________
Date
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Physical Therapist Assistant Program
General Education Course Worksheet
Name of Applicant: ______________________________________________________
Record the college and grades for courses completed. **Using the scales below, assign points for the grade earned. If a course has not been
completed or a grade of D or lower was received, zero points should be entered. Application points will not be awarded if the course & grade is not
HIGHLIGHTED on an enclosed CCC transcript. If currently enrolled in a general education course, spring semester 2016 points will be added to the
application score if a copy of an unofficial transcript with the grade earned is submitted to the Allied Health Secretary at the end of the semester.
This is the responsibility of the applicant and the transcript must be received by 3:00 PM May 17, 2016.
Course Name and Number
*BIO 201 Human Anatomy & Physiology I
(within last 10 years)
*BIO 202 Human Anatomy & Physiology II
(within last 10 years)
Academic
Institution
Letter
Grade
Points
Calculation**
Office only:
course/grade
highlighted?
ENG 101 English Composition I
MTH 100 Intermediate College Algebra or higher MTH
PSY 200 General Psychology
PSY 210 Human Growth & Development
SPH 106/107/116 Speech Elective
Humanities Elective: Art, Music, Foreign Language, Literature, Philosophy, Religion, Theatre
CIS 146 Microcomputer Applications
EMS 106 Medical Terminology for Health Professions
TOTAL=
(MAXIMUM GENERAL EDUCATION POINTS = 65)
For BIO 201 and BIO 202:
For all other courses:
A = 11 points
A = 6 points
B = 9 points
B = 4 points
C = 7 points
C = 2 points
Medical Terminology = 1 point if completed w/ grade C or higher
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Physical Therapist Assistant Program
Name of Applicant: ________________________________________________________________
Points Worksheet
All applicants must submit a copy of an ACT Reading Score or COMPASS Reading Assessment score from the past 3 years.
Circle your score and corresponding points.
ACT Reading
Score
18-19
20-21
22-23
24-25
26
COMPASS Reading
Score
80-82
83-85
86-88
89-90
91-92
PTA
Points
1
2
3
4
5
ACT Reading
Score
27
28
29
30-32
33-36
COMPASS Reading
Score
93-94
95-96
97
98
99
PTA
Points
6
7
8
9
10
To calculate your Academic Point total which includes general education course completion and the grades obtained in these
classes, and points based on the reading score from the ACT/COMPASS, fill in the blanks below. The maximum possible score for
this section is 75 points.
General Education points (from page 8 )
= ___________
(max. = 65)
ACT / COMPASS reading points (from grid) = ___________
(max. = 10)
Total ACADEMIC Score
(max. = 75)
Did you attend a PTA Program Information Session?
If yes, please check which session attended:
= ___________
 Yes
 No

 January 2016
October 2015
 March 2016
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Physical Therapist Assistant Program
Statements of Understanding
1.
Liability Release
I, _________________________, hereby acknowledge that I am eighteen years of age or older, or that if I am
under the age of eighteen I am signing this release with the written consent of my parent(s) or legal
guardian(s). I further acknowledge that I fully understand the contents of this release and that I am signing it
voluntarily.
As a student or a prospective student of the Physical Therapist Assistant Program at Calhoun Community
College, I am aware of the risk of personal illness and/or injury which are inherent in my participating in the
PTA educational activities.
Upon full awareness and consideration of the risks which I assume in participating in hospital or other clinical
rotation activities, I hereby agree to release Calhoun Community College and its instructors, officials, agents,
representatives, preceptors, and employees from any liability for any type of illness or injury which is incurred
during a period in which I am participating in clinical or laboratory activities.
_________________________________________
Student signature
Date
_________________________________________
Parent or guardian signature
If < 19 years of age
2.
Date
Statement of Understanding of Policy
I, _________________________, agree to abide by rules and policy set forth by the PTA program, the State of
Alabama Board of Physical Therapy, and my clinical affiliates that I visit during the course of my studies. I realize
that I have access to and a personal obligation to become aware of these rules. I have also been advised and
hereby indicate my understanding that PTA program policy requires a 75% or better average in all coursework
in any primary PTA course.
________________________________________
Student signature
Date
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3.
Physical Therapist Assistant Program Admission, Progression, and Graduation Contract
1.
I understand that falsification and/or omission of information on the College and/or PTA application shall be
grounds for dismissal from the program in accordance with College procedures.
2.
I understand that enrolled students in healthcare programs are required to submit to a background check and
drug screening by a vendor designated by the College to comply with clinical affiliate contracts. I understand
that the background check &/or a confirmed positive drug screen may render me ineligible to participate in
required learning experiences at clinical affiliates because I will be denied access. In this event, I understand
that I will be dismissed from the program and a grade of “F” will be recorded for course(s) if I do not officially
withdraw.
3.
I understand that enrolled students in healthcare programs are required to submit to a preclinical health
examination by a licensed physician or CRNP and to provide documentation of immunization to certain
communicable diseases and to undergo tuberculosis screening.
4.
I understand that I will be required to submit evidence of current CPR certification, a liability release, and must
purchase malpractice insurance by a deadline provided by faculty prior to clinical education experiences.
5.
In the clinical portion of the PTA Program, I understand that I must attend my scheduled clinical rotations
according to the program’s clinical rules and regulations. Failure to comply fully with these will result in my
receiving a lower grade or being ineligible to complete my clinical training due to my non-compliance. I agree
to read and know the Program’s Clinical Practice Policies and Procedures outlined in my student handbook
before entering any clinical area.
6.
I understand that I am required to abide by the rules and regulations of the clinical agency in which the clinical
component of each course is performed. Failure to do so will result in dismissal from the program and a grade
of “F” for the course assigned in accordance with College procedures.
7.
I understand that the clinical agency with which the program is affiliated has the right to request that a student
be removed from their facility, as well as the right to refuse a student admission to their facility for clinical
education.
8.
I understand that evaluation materials, i.e., clinical evaluations with instructor notations and counseling forms,
will be maintained in my student folder. I understand that upon my request, I have the right to see any
information that is retained in my student folder.
9.
Due to the nature of the training received in the PTA Program, I understand that there are risks in
demonstrating or receiving return demonstration in practical application of skills in the classroom segment. I
also understand that there are certain risks involved in completing clinical rotations with clinical affiliates of the
PTA Program at Calhoun Community College. I fully understand that I am not required to involve myself in any
activity that, in my opinion, would be potentially dangerous to me. I will not hold Calhoun Community College,
any of its’ employees, or other PTA students, any clinical instructor, or any PTA Program Clinical Affiliate
responsible for any injury occurred as a result of 1) any classroom practical application or 2) performing clinical
rotations.
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10. I understand that during my PTA education that I will come in contact with infectious diseases. I further
understand that my health and accident insurance and/or expenses are my responsibility.
11. I understand that I am responsible for transportation, meals, health care expenses and any liability incurred
during and while traveling to and/or from educational experiences.
12. I understand the application for licensure as a PTA will include a list of questions which ask, “Have you ever
been convicted of a felony or of a crime involving moral turpitude?” and “Have you ever been convicted of
violating any state or federal narcotic law?” and that application may be denied on the basis of this review.
13. I certify that I am of good moral character and that I have no known physical or mental difficulties that would
prevent me from completing this training program.
14. I understand that failure to comply with legal, moral, and legislative standards which determine unacceptable
behavior of the PTA and/or behavior which may be cause for denial of license to practice as a licensed PTA
constitute grounds for dismissal from the program, regardless of course standing. A grade of “F” will be
assigned for any PTA course from which the student is dismissed for unacceptable behavior.
15. I understand that the rules above apply to me in any PTA course I should take in the Physical Therapist Assistant
Program through Calhoun Community College, at the present or in the future.
16. I understand that it is my responsibility to read the College Catalog, each course syllabus, clinical evaluation
forms and other materials that are provided to the class which outline my responsibilities as a PTA student. I
understand that failure to abide by these published materials will be grounds for dismissal from the program.
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THAT THE CRITERIA STATED HEREIN AND IN THE
COLLEGE CATALOG APPLY TO ME AND THAT FAILURE TO ABIDE BY ANY STATED CRITERIA IS GROUNDS FOR
DISMISSAL.
_____________________________________________
Printed student name
_____________________________________________
__________________________
Student signature
Date
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4.
Statement of Understanding of Clinical Studies Component
As a student enrolling in a clinical studies component of the Physical Therapist Assistant program at Calhoun
Community College, I am aware that:
1. I will be enrolled in a clinical course that requires my presence at one or more health care facilities;
2. I am not an employee of the College or of the health care facility and if I am an employee of the College or
of the health care facility I must notify the PTA Program Director at the beginning of my PTA education
coursework at Calhoun Community College;
3. I do not expect and will not receive compensation from the College or health care facility for participation
in the clinical course; and
4. I have not been promised and do not expect to be offered a job at the health care facility as a result of
participation in the clinical course.
5. I may be required by the hospital/clinical site to undergo drug and/or alcohol testing at any time as a
precondition to beginning a clinical rotation or to continue a clinical rotation at the hospital/clinical site.
6. I will be required to purchase medical malpractice Insurance at an approximate cost of $20.00. This fee will
be added to my class tuition the semester of my first clinical experience. If I am attending classes on loans
or grants, which do not pay this fee, I will contact the PTA secretary immediately to arrange payment prior
to beginning clinical rotations.
____________________________________________
Student signature
5.
Date
Information for PTA Student Applicants:
I understand that completion of this application is a component of the student profile and does not in itself
grant admission to the Physical Therapist Assistant Program. I understand I must submit a new application if I
am not selected and choose to apply in the future. I certify that the information given in this application is true
and correct. I understand that providing false information may be deemed sufficient reason to dismiss a
student and/or refuse admission.
Minimum admission standards include:
1. Unconditional admission to the college
2. Receipt of a completed PTA Program Application packet
3. An unofficial CCC transcript documenting all courses and grades taken at Calhoun &/or accepted in transfer
4. An ACT or COMPASS reading score from the past three years
5. Twenty-four hours of documented physical therapy observation
6. A 2-3 page typed essay discussing my physical therapy observation experience
7. Two professional letters of recommendation.
Admission to the Physical Therapist Assistant Program is competitive, and the number of students is limited by
the number of faculty and clinical facilities available. Meeting minimal requirements does not guarantee
acceptance.
______________________________________________
Student signature
Date
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6.
PTA Program Essential Functions
Title III of the 1990 American with Disabilities Act provides comprehensive civil rights protection for “qualified
individuals with disabilities. The Alabama College System endorses the Americans’ with Disabilities Act. If you have a
disability that might require special materials, services, or assistance, please contact Calhoun’s Disability Services Office
in the Chasteen Student Center, Room 218 (Decatur Campus) or call (256) 306-2630 or (256) 306-2635.
The mission of the Physical Therapist Assistant Program is dedicated to the academic and clinical education of
individuals who will function as care providers in a multiplicity of settings in which PTAs practice. Implicit in the
Program’s curriculum is the development of skills for treatment and therapeutic client interactions.
Based on its mission, the Physical Therapist Assistant Program’s intent is to educate a competent entry-level physical
therapist assistant who can treat the general population of acute and rehabilitation patients in current health care
settings. Enrolled students are required to successfully complete both the academic and clinical requirements of the
program to receive the AAS degree. The purpose of the following is to delineate the cognitive, affective and
psychomotor skills deemed the minimal essential functions necessary for admission, progression, and graduation and
for the provision of safe and effective patient care. If a student cannot demonstrate the following skills and abilities, it
is the responsibility of the student to request appropriate accommodations through the Office of Disabled Students.
Cognitive learning skills: the student must be able to demonstrate the following abilities:
1.
2.
3.
4.
Retain and use information in the cognitive, psychomotor, and affective domain in order to treat patients.
Perform a physical therapy assessment of a patient’s posture and movement including analysis of physical,
biomechanical, and environmental factors in a timely manner, consistent with the acceptable norms of all
clinical settings.
Use information to execute physical therapy treatment in a timely manner appropriate for the problems
identified and consistent with the acceptable norms of all clinical settings.
Reassess the treatment plan as needed for effective and efficient management of physical therapy problems in
a timely manner, consistent with the acceptable norms of all clinical settings.
Affective learning skills: the student must be able to demonstrate the following abilities:
1.
2.
3.
Demonstrate appropriate affective behaviors and mental attitudes in order to not jeopardize the emotional,
physical, mental, and behavioral safety of patients and other individuals with whom one interact in the
academic and clinical setting and to be in compliance with the ethical standards of the American Physical
Therapy Association.
Cope with the mental and emotional rigors of a demanding educational program in physical therapy that
includes academic and clinical components that occur with set time constraints and often concurrently.
Acknowledge and respect individual values and opinions in order to foster harmonious working relationships
with colleagues, peers and patients.
Psychomotor skills: the student must be able to demonstrate the following skills:
1. Sit and maintain upright posture.
2. Stand and maintain upright posture.
3. Locomotion:
a. Arrive at lecture, lab, and clinical locations in a timely manner
b. Move within rooms as needed for changing groups, lab partner and work stations, and perform
assigned clinical tasks
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4.
5.
6.
7.
8.
9.
Manual tasks:
a. Safely maneuver self or move another individuals’ body parts to effectively perform evaluation
techniques
b. Safely maneuver or move clinical equipment from side to side, forward and backward or from a lower
to a higher position.
c. Manipulate common tools used for screening tests of the cranial nerves, sensation, range of motion,
and muscle testing procedures (e.g. cotton balls, safety pins, reflex hammer, and goniometer)
d. Safely and effectively guide, facilitate, inhibit, and resist movement and motor patterns through the
use of facilitation and inhibition techniques, including ability to give time urgent verbal and sensory
feedback.
e. Safely move another individual’s body in transfers, gait, positioning, exercise and mobilization
technique.
f. Safely manipulate and move equipment and items to aid in the treatment of a patient (i.e. bolsters,
pillows, plinths, mats, gait assistance devices, other supports or chairs, IV’s, monitors, etc)
g. Competently perform CPR using guidelines issued by the American Heart Association or the American
Red Cross.
Fine motor/hand skills:
a. Legibly record/document progress notes in standard medical charts in hospital/clinical settings in a
timely manner and consistent with the acceptable norms of clinical settings.
b. Legibly record thoughts for written assessments
c. Palpate changes in an individual’s muscle tone, soft tissues, skin quality, joint play, kinesthesia, and
temperature in a timely manner and sense that individual’s response to environmental changes and
treatment
d. Apply and adjust therapeutic modalities
e. Apply and effectively position hands to apply soft tissue and mobilization techniques
Visual Acuity:
a. Obtain visual information from clients (e.g. movement, posture, body mechanics and gait pattern)
b. Obtain visual information from treatment environment (e.g. dials on equipment, assistive devices,
furniture placement, and floor surfaces)
Communication skills:
a. Effectively communicate in English with other students, faculty, patients, peers, staff and families to
ask questions, explain conditions and procedures, teach home programs, and to maintain safety in a
timely manner and within the acceptable norms of academic and clinical settings
b. Receive and interpret written communication in both academic and clinical settings in a timely manner
c. Receive and send verbal communication in life threatening situations in a timely manner within
acceptable norms of clinical settings
Self-care:
a. Maintain general good health, self-care and hygiene in order not to jeopardize the health and safety of
self and individuals with which one interacts in the academic and clinical settings
b. Arrange transportation and living accommodations for/during off campus clinical assignments to
foster timely reporting to the classroom and clinical site.
Auditory:
a. Effectively auscultate lungs, apical pulse, and blood pressure.
I have reviewed the Essential Functions for the PTA program.
________________________________________
Student signature
Date
15
PTA PROGRAM APPLICANT
PROFESSIONAL RECOMMENDATION
Applicant Name
__________________________________________________________________
1. How long have you known the applicant?
___ Less than 30 hours of observation experience
___ Less than 6 months
___ 6 months to 1 year
___ 1 - 3 years
___ 3 - 5 years
___ Greater than 5 years
2. In what capacity have you been able to observe the applicant’s attitude and personal behaviors?
___ As a student
___ As an employee
___ Through Physical Therapy Observation Hours
___ Other, please describe_________________________
3. Using the following rating scale, please rate the applicant regarding:
3 – Above Average 2 – Average 1 – Below Average
___
___
___
___
___
___
0 – Unable to rate
Demonstration of ethical and professional behaviors and/or demeanor
Ability to manage stress
Acceptance of constructive criticism
Personal hygiene & attire appropriate to situation
Maturity
Relationships, conversation, and conduct appropriate to environment
4. Would you recommend this applicant for admission to the PTA Program?
___ Without reservation
___ With some reservation
___ With concern
___ Unable to recommend this applicant
Please provide your comments on this applicant on the following page. Thank you.
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Please use the following space to explain your relationship with the applicant (teacher, supervisor, employer,
coach, etc.) and for comments you would like to include in regards to this applicant entering the professional
component of the PTA program at Calhoun Community College. All information on this document is kept in
strict confidence and will be accessible only to the PTA program faculty. Following the admissions process for
this year, this document will be destroyed.
COMMENTS:
The applicant is required to turn in their professional recommendations with the PTA Program Application.
Therefore, when you have completed this confidential document, please fold, seal in a standard lettersize envelope, and sign across the seal before returning to the applicant.
__________________________________
Please type or print name
______________________________________
Position or Title
______________________________________
Place of employment
______________________________________
Telephone Number
__________________________________
Signature
_______________________________________
Date
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