TEXAS SOUTHERN UNIVERSITY
COLLEGE OF PHARMACY & HEALTH SCIENCES
DEPARTMENT OF HEALTH SCIENCES
HEALTH ADMINISTRATION PROGRAM
Application Deadline ______________
(Note: Applications submitted after the deadline are considered non-responsive.)
GENERAL INFORMATION
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Place completed applications in a sealed envelope. Only completed applications will be
reviewed.
Applications are accepted April 1 through April 15 (or on the next business day) of each
year for Fall acceptance. Applications are accepted October 1 through October 15 (or on
the next business day) of each year for Spring acceptance. Applications submitted after
the deadlines are considered non-responsive, and will not be accepted by the program.
Applications are due by 5:00 pm on the due date in NSC 202.
Applicants must have been accepted to the University.
Transfer/Advanced Standing applicants must meet both the requirements for admission into
the University and those of the Health Administration Program.
Required Documents and Submission Process
Health Administration Program Application
Official Transcripts
Transcript Evaluation (see advisor)
Essay (describing applicant’s background and interest in the health care profession,
must be typed and not exceed 2 pages)
3 Letters of Recommendations (use attached forms)
Place all documents in a sealed envelope with your name and program for which
you are applying.
Submit complete application (containing all documents) in the sealed envelope to
the Health Sciences Main Office-NSC 202. You must verify your submission by
signature. Applicants will be notified of application status within 30 days of
application deadline.
(Rev. 03/2012)
HEALTH ADMINISTRATION PROGRAM APPLICATION
PLEASE PRINT OR TYPE:
Name (Last)
_____________________
I D Number
(First)
_________________
Cell Phone
______________________
Current Telephone
___________________________________________________
E-Mail Address
Current Address
City
Permanent Address
City
(Middle)
_______________
Permanent Telephone
State
Zip Code
State
Zip Code
EDUCATIONAL INSTITUTIONS ATTENDED- List in Chronological Order (last Institution first) all Colleges, Universities, or
Other Post Educational Institutions attended.
Name of Institution (Do Not
Abbreviate)
Dates
Attended
Credits/Hours Earned
Per/Semester
Credit/Hours
Earned Per/Quarter
Degrees/Certificates
Earned (if any)
Applicant Signature _______________________________Date:_______________
Submit typed narrative essay (maximum 2 pages) and attach to
application.
Accommodations for students with disabilities will be made in accordance with the University’s policy to
adhere to the American Disabilities of 1990,and section 504 of the Rehabilitation Act of 1973 to ensure
full compliance with these federal mandates in these courses through reasonable adjustments and
services to students with known disabilities, who are eligible and meet the requirements of the academic
program apart from the disabling condition, while protecting the confidentiality and privacy of any
students with disabilities.
(Rev. 03/2012)
Texas Southern University
College of Pharmacy and Health Sciences
Department of Health Sciences
HEALTH ADMINISTRATION PROGRAM
Applicant Recommendation Form
Applicant Name: ______________________________
TO THE RECOMMENDER: The above-named student has applied for admission to the Health Administration
Program. Someone who has previously taught this student and/or has known the applicant for at least a one-year period
must complete this section. We appreciate your candid appraisal of the student. Your recommendation may be given to
the student in a sealed envelope or you may mail it directly to: Texas Southern University College of Pharmacy and
Health Sciences Health Administration Program_,3100 Cleburne Ave., Houston, Texas 77004.
1. Please evaluate the applicant on the following characteristics by checking the appropriate number. The applicant
should be rated on a scale of 1-10 (with “1” representing the lowest rating, and “10” representing the highest
rating.) If you are unable to rate a particular characteristic, please enter “NA” which will indicate unknown.
Please attach a letter of recommendation as desired.
CHARACTERISTIC
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3
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5
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Personal Appearance
Academic Ability
Self-Confidence
Work Habits
Motivation Towards Program
Seriousness of Purpose
Potential for Contribution /
Commitment to Profession
(enthusiasm, professional demeanor,
knowledge level)
Resourcefulness and Initiative
(self starter, work habits, followthrough, ability to work
independently)
Maturity (self control, emotional
stability, acceptance of constructive
criticism)
Adaptability
Communication Skills
Oral
Written
Listening
Teamwork (ability to work with others,
cooperative disposition)
Reliability (promptness,
conscientiousness, dependability)
Integrity (moral character, honesty)
Leadership skills (ability to inspire,
confidence)
Intellectual curiosity (interest in learning,
active learner, creative thought)
Empathy (sensitivity to needs of others,
caring attitude toward others)
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How long have you known this applicant? _________________________
In what capacity have you known the applicant? _____________________
Your best estimate of the applicant’s overall potential for success in the Health Administration Program.
______Poor _______Below Average ______Good _____Outstanding
Recommender’s Signature : ______________________________
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10
Department of Health Sciences Application Checklist
APPLICANT PROCESSING CHECK LIST
PROGRAM:__________________________________
SEMESTER: _________________________________
LAST NAME: __________________FIRST NAME___________________
T-NUMBER:__________________________________
Transcripts Included:
YES
NO
COMMENTS:
Complete Incomplete
APPLICATION
LETTERS OF
RECOMMENDATION (3)
ESSAY
GPA
TRANSCRIPTS
TRANSCRIPTEVALUATION