PTA Military Bridge Program Application Student InformationWe will attempt to contact you about your program application through one or more of the contact methods you provide. If we are unable to reach you, this may result in your inability to start the program.Full Legal Name * Required First Last Preferred Name Preferred Pronouns Preferred Name Requests Students may request that their “Preferred Name” be different from their legal name of record in the system. If you enter a preferred name, it will appear on class lists and adjust your email address to reflect your preferred name.Student ID or Star ID * Required Phone Number * RequiredMay we contact you using the phone number listed if we have questions about your applicationYesNoPreferred Email Address * Required Alternate Email Address Address * Required Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code This application must be complete for consideration for program admission. Before applying to the ALLIED HEALTH PROGRAM please review your Degree Audit Report (DARS) for the following information. (How to read your report).Semester to start coursesSelect oneFallSpringSummerYear to start courses Military StatusSelect oneActiveReserveHonorable DischargeDate of Honorable Discharge Year completed phase 2 training or Journeyman * Required(Army/Navy, Coast Guard) or CCAF Journeyman (USAF) By submitting this application, I agree to the following:I have been accepted for admission at Lake Superior College or I am a current degree seeking student * RequiredYesNoNot an admitted student? Please pause your application to this program and apply to the college. Remember to come back to this application to apply after you are admitted to the college. Please note that Lake Superior College does not require transcripts to be admitted, you will need to make sure to have your official transcripts sent to the admissions department if you have any transfer courses for this program.I have declared PTA - MIlitary Bridge as my academic program of interest when I applied to Lake Superior College or by working with a Lake Superior College advisor * Required Agree I have reviewed and met the pre-program English/reading, and math requirements as outlined on the program guide. * Required Agree Status of pre-program courses * RequiredCompleted all pre-program coursesCurrently finishing final pre-program coursesI understand I can apply with pre-program requirements in-progress. Priority will be given to students who have pre-program requirements completed and apply by the application deadline. * Required Agree I understand that if information is missing from my file, or the application is incomplete, I will NOT be admitted into the program. * Required Agree I understand that any falsification of information will result in disqualification of my application. * Required Agree I understand that program acceptance will be sent to my preferred email address listed on this application. * Required Agree I will not register for PTA - Military Bridge courses until I have received official acceptance in the program. * Required Agree I understand that I need to request my Joint Services Transcript (Army/Navy, Coast Guard) or CCAF Transcript (USAF) be sent to Lake Superior College. * Required Agree I understand that I am not eligible for the PTA Program until I have completed at least 6 months’ of work experience as a PT Specialist/PT Tech after Phase 2 military training (Army/Navy, Coast Guard). * Required Agree I understand that Phase 2 training does not count toward the 6 month work experience requirement. For Air Force canidates, if Journeyman training was 9 months or longer, this will count as the work experience requirement. * Required Agree I understand I need to obtain a recommendation from a PT who supervised me for at least 6 months during the required work experience period. The recommendation must be on the specific form required by the LSC PTA Military Bridge Program and must be sent directly from the supervising P.T. to Jane Worley at ptamilitarybridge@lsc.edu * Required Agree I understand my supervising P.T. also needs need to complete a Skills Documentation Log form and send it as part of my program application to ptamilitarybridge@lsc.edu. * Required Agree I understand that if my military training occurred prior to January 2006, I must petition acceptance of these earlier training dates through the LSC petition process and that the result of such a petition is not guaranteed. * Required Agree If honorably discharged I must submit my DD-214 form to Lake Superior College. * Required Agree I understand I am responsible for securing needed financial aid for this program and that the LSC Financial Aid office can be contacted with questions at (218) 733-7601. * Required Agree I understand I will be required to complete two online orientations; one is for the college and one is for the PTA program. * Required Agree I have read the program eligibility requirements and attest that the information provided as part of my application to the college and program is complete and accurate. * Required Agree I understand that in order to graduate from the program, I will be required to pass a comprehensive final exam similar in difficulty level to the National Physical Therapy Examination; this will occur during my final semester in the program as part of PTA 2780. I will be given more than one attempt to pass this final exam, but requiring a re-take will most likely delay graduation from the program. The current first-time pass rate for this comprehensive final exam is 40-60%. Each attempt on the exam must be proctored as per current exam proctoring policies. * Required Agree I understand that if I earn a grade of D, F, or FN (failure for non-attendance) in any technical program course (i.e., PTA 2680, 2682, 2780), I will be considered to be in PTA Program Academic Probation status, and will be moved to the bottom of the priority list for the current academic year for seats in technical program courses. Student who formally withdraw from the course prior to the withdrawal deadline will not be penalized for the first withdrawal from any course. * Required Agree I understand that graduates of accredited PTA programs are qualified to sit for the National Physical Therapy Examination (NPTE). Passing the NPTE is a requirement in all 50 states. Licensure in any particular state is controlled by the state licensing board in that state and other factors, such as background studies and criminal history, may affect a graduate's ability to obtain licensure. Students/graduates may find information about licensure requirements in the state in which they want to practice through the web site for the Federation for State Boards of Physical Therapy (www. fsbpt.org) * Required Agree The LSC PTA - Military Bridge program was designed as a degree-completion program for military-trained physical therapy personnel. Earning the AAS-PTA degree qualifies candidates to out for the NPTE. Please comment on your plans to seek licensure as a civilian PTA in terms of location and timeline. Please also elaborate on your reasons for seeking the AAS-PTA degree. * Required
