Dear Prospective Applicant:

Dear Prospective Applicant:

Thank you for your interest in the Doctor of Physical Therapy Program offered

within the School of Graduate Medical Education at Seton Hall University.

The Doctor of Physical Therapy (DPT) program is fully accredited by the

Commission on Accreditation in Physical Therapy Education. Our comprehensive

educational program including clinical internships is full-time, four years in length, and

culminates in a Doctor of Physical Therapy degree. Graduates of the program will be

thoroughly prepared for the Physical Therapy Licensure Examination. After successful

completion of this examination, the individual will become licensed as a physical

therapist. All states require licensure in order to practice physical therapy.

Enclosed in this mailing are documents about the program and an application

package. Please read the Application Instruction Sheet carefully before completing the

application. Be sure to check the appropriate program you desire to attend. The

application deadline for early admission is November 15, and for regular admission is

February 15. Candidates will be notified of decisions by December 1, and March 15,

respectively. Admissions may remain open beyond the February 15 deadline if the class

is not filled.

Should any questions arise during the application process, please contact the

Departmental Secretary at (973) 275-2051.

Sincerely,

Marc Campolo, PT, PhD, SCS, ATC, CSCS

Updated 6/16/05

Application Instruction Sheet for the Doctor of Physical Therapy Program

Please provide the following documentation.

A. Physical Therapy Program Admission Application:

1. Type or print clearly all information unless otherwise indicated

2. Indicate any name(s) that you have previously used, such as a maiden name. 3. Place your name on every sheet of the application.

4. Submit a check or money order for $75.00 payable to Seton Hall University to cover the application fee.

B. Application Essay Instructions

Write an essayto describe, chronologically, your academic and personal preparation for the Doctor of Physical Therapy Program. Refer to your application material whenever necessary. Type the essay on a separate piece of paper. Do not exceed 2 double space pages.

C. Official transcripts from all colleges, universities and/or professional schools attended.

1. Official sealed transcripts must be submitted with your application materials. 2. All transcripts from outside the United States must be evaluated course by course

by a recognized transcript evaluation agency. Translations alone will be

accepted. We recommend: World Education Services (WES), PO Box 745, Old Chelsea Station, New York, NY 10113-0745. Telephone: 800-937-3895 or email www.wes.org.

3. International graduate students are required to submit Test of English as a Foreign Language (TOEFL) submitted with application materials.

D. One letter of recommendation must be from a licensed physical therapist who may have been a supervisor for the clinical observation.

E. Two additional letters of recommendation from personal or professional sources. All letters of recommendation must be completed on the enclosed forms.

F. Read and sign Essential Functions Document

G. Complete Academic Prerequisite Coursework Checklist

H. Complete Observation Hours Verification form (At least 50 hours of clinical observation under a licensed Physical Therapist is required.)

Updated 6/16/05

I. Submit official copy of Graduate Record Examination (GRE) scores. Contact the GRE Education Testing Services at: (609) 771-7670 for examination dates. The GRE Codes are:

Department Code: 0619 Physical Therapy Institutional Code: R2811 Seton Hall University

State Code: 31 New Jersey

NOTE:

The candidate must submit all application materials in the envelope provided before February 15 (early review deadline is November 15). Priority will be given to all

applications received by this date; however, admissions will remain open until the class is filled.

Yes No If yes, what year?

Month/Year Are you applying to study:

Term of entry:

Name

First Name Middle

Last Name

Mailing Address

School of Graduate Medical Education

Number and Street

City State/Province Zip + suffix

Country

Address valid until:

Permanent Address

Number and Street

City State/Province Zip + suffix

Country

Social Security Number Gender Male Female

Date of Birth

Month/Day/Year

Email

Telephone and Fax Numbers

Current Home Telephone Work Telephone Fax Number

(May we contact you here?) Yes No

Country / Area Code / Number Country / Area Code / Number Country / Area Code / Number

(May we contact you here?) Yes No Have you previously applied for admission?

Citizenship Country(ies) of Citizenship:

Non - U.S. citizens only: Are you a U.S. permanent resident? Yes No Visa Type:

Marital Status (optional) :

Testing Information Education - -( ) / / -/ ( ) ( ) / /

Undergraduate Grade Point Average (if available)

Please list all post-secondary colleges, universities, or institutions attended, including those attended for summer session or evening classes. OFFICIAL transcripts from all colleges and universities attended including those attended for less than one full semester/quarter must be provided.

Ethnic Background (optional) :

(or plan to take) (or plan to take)

Total Analytical

Date taken GRE

Month/Year

Verbal Quantitative Total

TOEFL (for international applicants only)

Section 3 Date taken Month/Year Section 1 Section 2 Score Score Score Score Score Score Score Score Title Mr. Ms. Sr. Dr. Other

Other names your records may be under

Place of Birth

Religious Affiliation (optional) :

To which other graduate schools have you applied? PLEASE SELECT A PROGRAM OF INTEREST:

Full time

Physical Therapy (Entry-Level)

Mobile Phone

Country / Area Code / Number

( )

(May we contact you here?) Yes No

/ - /

Name of school Dates attended Degree received Major field

/ - / / - / / - / / - / CEEB Type

References Please list your evaluators. 1. Name Mailing Address 2. Name Mailing Address 3. Name Mailing Address Employment History

Beginning with your most recent job, please list below in reverse chronological order each of the jobs you have had since the beginning of your college studies. Please account for all periods of time. You may use the "Additional Information" page if necessary.

Current

From To or

(month/year)

Employer (month/year)

Employer Nature of Business Location

/ /

Source(s) of

Information How did you learn about the Program?

Position/Job Title: From (month/year) Employer (month/year) Location / / Position/Job Title: From To (month/year) Employer (month/year) Location / / Position/Job Title: To

Employer Nature of Business

Employer Nature of Business

Current or Relationship to applicant Relationship to applicant Relationship to applicant ( )

Phone Number E-mail

( )

Phone Number E-mail

( )

Phone Number E-mail

(One letter of recommendation must be from a licensed Physical Therapist who may have been a supervisor for the clinical observation.)

Volunteer Experience

See Application Instruction sheet for details.

1. Name Number of Hours

Location

2. Name Number of Hours

Location

3. Name Number of Hours

Prerequisites Please provide the following information concerning each of the prerequisites you have taken.

Institution Semester/Year Final Grade

/ / / / / / / / / / / / Human Anatomy & Physiology I (4 credits)

Human Anatomy & Physiology II (4 credits) Physics I (4 credits)

Physics II (4 credits) Chemistry I (4 credits) Chemistry II (4 credits)

College Math or Statistics (3 credits) English/Communication (3 credits) English/Communication (3 credits) Social Sciences (3 credits) Social Sciences (3 credits) Social Sciences (3 credits)

ADDITIONAL INFORMATION

Produced with Embark

Transcript Request

Please forward an official copy of my academic transcript to:

Seton Hall University

School of Graduate Medical Education

Attn: Deborah Verderosa

400 South Orange Avenue

South Orange, NJ 07079

Name

M.I.

First

Last

Address

Street

Number

Zip

State

City

(Evening)

Telephone (Day)

Social Security Number

Date of Birth

Year

Month

Day

Thank you for your attention to my request. Please advise me of any fee for this

service.

Date

Signature

-DOCTOR OF PHYSICAL THERAPY

RECOMMENDATION

Applicant SS#

LAST FIRST MI

RECOMMENDATIONS FROM FRIENDS, FAMILY MEMBERS,

OR ACQUAINTANCES ARE NOT ACCEPTABLE.

To the Applicant:

Complete the top portion of the form and give it to the person making the recommendation.

Right to Access:

This letter of recommendation is confidential. Such letters are not accessible to applicants for admission.

However, Public Law 93-380, Educational Amendments Act of 1974, grants enrolled students the right to inspect letters of recommendation. If the applicant does not waive the right to access and is admitted and enrolled, he or she will be able to access these letters.

Please check one: I do, do not waiveright to access this letter.

SIGNATURE OF APPLICANT DATE

To the Recommender:

Complete questions 1 through 5; your signature is required on the second page of this form. There is space provided on the second page to provide additional information and/or comments about the applicant that could be considered relevant to his/her admission to our program.

employ eagerly

1. In what capacity have you known the applicant?

2. How long have you known the applicant?

3. Place a check mark next to the response that best indicates your opinion if you were in a position to employ the applicant:

employ with satisfaction

employ with reluctance would not consider employing

Place a check mark next to the response that best represents your opinion if you were in a position to decide whether the applicant should be accepted for a program of study leading to a health care profession:

4.

definitely accept probably accept

probably reject definitely reject

5. Please complete the following:

Please feel free to use the space below to provide additional information and/or comments about this candidate that could be considered relevant to his/her admission to our program.

Signature Date

Name (print) Title

Address

Telephone ( ) 6.

Attribute No Basis for

Evaluation Very Poor Below Average Average Above Average Outstanding a. Character and personal integrity

b. Emotional balance and maturity c. Poise and personal appearance d. Scholastic ability

e. Ability to work with professional associates f. Success in working with children/youth/adults g. Demonstration or promise of professional growth h. Demonstration or promise of professional leadership

School of Graduate Medical Education

Observation Hours Verification Form for the DPT program

Make additional copies of this form as needed.

This is to verify that __________________________________ has completed ______

observation hours with me at ______________________________________________.

_______________________________________

Name and credentials (please print)

_______________________________________

Signature

_______________

Date

DOCTOR OF PHYSICAL THERAPY PROGRAM

CHECKLIST: ACADEMIC PREREQUISITE COURSEWORK

Directions: Please fill in the spaces below with the information related to each of the

prerequisites for the program.

NAME

ANTICIPATED ADMISSION DATE

________________________

Institutions Attended (

)

COLLEGE/UNIVERSITY

(Full Name)

Semester

Year

Degree

Granted

A

B

C

D

C

: B

S

Chemistry (8 credits), Physics (8 credits), Human A & P (8 credits)

Institution

Course Name

Credits

Grade

______

__________________

______

______

______

______

______

__________________

________________________

______

______

S

C

: B

& S

S

:

Social Sciences (9 credits), English/Communications (6 credits)

Institution

Course Name

Credits

Grade

_____

_____

_____

_____

__________________

________________________

______

_____

__________________

________________________

______

_____

S

______

C

:

Calculus/ Statistics (3 credits)

Institution

Course Name

Credits

Grade

S

______

STANDARDS FOR ESSENTIAL FUNCTIONS

Seton Hall University-School of Graduate Medical Education is committed to the education of all qualified individuals, including persons with disabilities who, with or without reasonable accommodation, are capable of performing the essential functions of the educational program in which they are enrolled and the profession that they pursue.

It is the policy of each of the graduate programs in the Seton Hall University, School of Graduate Medical Education to comply with the American with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, and state and local requirements regarding students and applicants with disabilities. Under these laws, no otherwise qualified and competent individual with a disability shall be denied access to or participation in services, programs, and activities solely on the basis of the disability.

Essential Functions/Technical Standards for Graduate Enrollment

In accord with the federal regulations established by the Americans with Disabilities Act, the following standards are described to assist each candidate in evaluating his/her prospect for academic and clinical success. General standards for the School of Graduate Medical Education are followed by standards that apply to the professional discipline to which you have applied (see additional standards below). When a student’s ability to perform is compromised, the student must demonstrate alternative means and/or abilities to perform the essential functions described.

It is important that each student reads each standard carefully. By signing the appropriate Certification Statement below, the student certifies that s/he has read and understands these standards, and to the best of his/her knowledge meets each standard.

Observation Skills:

Students must be able to acquire a defined level of required information as presented through educational experiences in both basic arts and sciences and clinical sciences. To achieve the required competencies in the classroom setting, students must perceive, assimilate, and integrate information from a variety of sources. These sources include oral presentation, printed material, visual media, and live demonstrations. Consequently, students must demonstrate adequate functional use of visual, tactile, auditory and other sensory and perceptual modalities to enable such observations and information acquisition necessary for academic and clinical performance.

Communication Skills:

Effective communication is critical for students to build relationships with faculty, advisors, fellow graduate students, coworkers, clients, and their significant others in the student’s various roles of learner, colleague, consultant, and leader. Students must be able to gather, comprehend, utilize and disseminate information effectively, efficiently and according to professional standards. Students are required to communicate in the English language both verbally and in writing, at a level consistent with competent professional practice. Students are expected to use grammar and vocabulary proficiently. They must be able to elicit information, gather information, and describe findings verbally and in writing (e.g., in a physical examination record and treatment plan). This communication should be comprehensible by patients, professionals, and laypersons.

Students must be able to communicate effectively and sensitively with patients and colleagues, including individuals from different cultural and social backgrounds; this includes, but is not limited to, the ability to establish rapport with patients and communicate effectively judgments and treatment information. They should also be able to observe, recognize and understand non-verbal behavior.

2

Intellectual/Conceptual Abilities:

Students must possess the motor functions needed to manipulate tools or handle clients. These functions will vary depending on the particular program (See additional standards below). The motor capacities usually include the physical strength and coordination to safely handle and move clients, perform medical procedures, or direct clients in various practice settings according to the needs of their discipline.

Behavioral and Social Skills:

Students must demonstrate emotional stability and acceptable communication skills, and be capable of developing mature and effective interpersonal relationships with other students and health care workers. Students must be able to tolerate physically and emotionally taxing workloads and to function effectively under stress. They must be able to adapt to changing environments, display flexibility, and function in the face of the uncertainties inherent in the clinical setting.

Students must exhibit the ability and commitment to work with individuals in an intense setting to meet the needs of people of diverse cultures, age groups, socioeconomic groups and challenges without bias. These individuals may be severely injured; they may be limited by cognitive, emotional and functional deficits; and their behavior may create at times an aversive reaction. The ability to interact with these individuals without being judgmental or prejudiced is critical in establishing one’s professionalism and therapeutic relationship. Compassion, integrity, concern for others, interpersonal skills, interest and motivation are all personal qualities that are critical to complete each program.

Professional Responsibility:

Students must exhibit the ability to meet the challenges of any medical situation that requires a readiness for immediate and appropriate response without interference of personal or medical problems. This requires training for emergencies (e.g., CPR, infection control).

It is each student’s responsibility to attend and be able to travel to and from classes and clinical assignments on time, and possess the organizational skills and stamina for performing required tasks and assignments within allotted time frames. This involves frequent oral, written, and practical examinations or demonstrations. The student must have the ability to perform problem-solving tasks in a timely manner.

Students will exhibit adherence to policies of the university, their program, and clinical sites. This includes matters ranging from professional dress and behavior, to attending to their program’s academic schedule, which may differ from the University’s academic calendar and be subject to change at any time.

Students must demonstrate knowledge of and commitment to the code of ethics of their profession and behavior that reflects a sense of right and wrong in the helping environment.

Students will take initiative to direct their own learning. They need to work cooperatively and collaboratively with other students on assigned projects, and participate willingly in a supervisory process involving evaluation of abilities and reasoning skills.

3

In addition to the general standards above, students applying to the Physical Therapy program must consider the following requirements.

Categories Definition Examples

Critical Thinking Ability for sufficient clinical Identify cause-effect relationships in clinic.

thinking judgment. Develop patient goals/plans. Respond to

emergencies. Apply universal precautions.

Apply teaching and learning theories in

health care.

Interpersonal Skills Sufficient ability to interact with Establish rapport with patients, clients, groups from a variety of backgrounds and colleagues. Recognize psychosocial

impact of dysfunction/disability.

Integrate the needs of the patient and

family into plan of care.

Communication Ability to communicate in Explain treatment procedures. Initiate

Ability verbal and written form health teaching. Document and interpret

physical therapist actions and patient

responses.

Mobility Skills Physical ability sufficient to move Move around in patients’ rooms and from room to room and maneuver treatment spaces. Administer CPR

in small spaces procedures. Transfer patients and

respond to emergencies.

Motor Skills Gross and fine motor abilities Calibrate and use equipment. Position

sufficient to provide safe and patients/clients. Guard and assist with

effective physical therapy ambulation. Perform full-body ROM,

debridement, transfers, CPR, or use of

physical agents. Able to life, carry, pull,

push, reach, stand, walk, kneel, bend, climb,

balance, and operate electrical equipment.

Hearing Ability Auditory ability sufficient to Hear and monitor alarms, emergency

monitor and assess health records signals, and cries for help and respond to a timer.

Visual Ability Visual ability sufficient to monitor Observe patient’s responses. Monitor

and assess health needs vital signs, read stopwatch.

Tactile Ability Tactile ability for physical Perform palpation, physical examination

assessment or intervention, resistance during

exercises or assessment.

Coping Skills Ability to perform in stressful

Environment or during

impending deadlines

Behavioral Skills Ability to demonstrate Practice safely, ethically, and legally.

professionalism Participate in scientific inquiry.

Demonstrate responsibility for lifelong professional growth and development.

4

CERTIFICATION STATEMENT STUDENTS NOT REQUESTING ACCOMMODATIONS:

I certify that I have read and understand the standards of essential functions both for the School of Graduate Medical Education and for the Doctor of Physical Therapy Program. I believe to the best of my knowledge that I meet each of these technical standards without accommodation. I understand that if I am unable to meet these technical standards I will not be admitted to the program.

________________________________________________________________

Print Student Name

________________________________________________________________

Student Signature Date

STUDENTS REQUESTING ACCOMMODATIONS:

I certify that I have read and understand the standards of essential functions both for the School of Graduate Medical Education and for the Doctor of Physical Therapy Program. I believe to the best of my knowledge that I can meet each of these technical standards with certain accommodations. I will contact the University Disability Support Services to determine what accommodations may be available. I understand that if I am unable to meet these technical standards with or without accommodations, I will not be admitted into the program.

________________________________________________________________

Print Student Name

________________________________________________________________

Student Signature Date

I acknowledge that the above student has contacted the Disability Support Services. __________________________________________________________

DSS Signature Date

REFERENCES

Ranel A, Wittry AS, Boucher B, Sanders B. (2001) A survey of Essential Functions and Reasonable Accomodations in

Physical Therapist Education Programs. Journal of Physical Therapy Education, 15(1).

Scott, S., Wells, S. Hanebrink, S. (1999) Educating College Students with Disabilities: What

Academic & Fieldwork Educators Need to Know. Bethesda, Md: AOTA, Inc.

Gleenson, P.B., & Utsey, C. (2000). Manual for the PT and PTA ACCE. Texas Consortium for