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Physician Assistant Program Application

PA Program Registration Information

Welcome to the Physician Assistant Program Registration!

Please create your account login information and begin answering the application questions.

If you have already registered, click here to login.

Once you submit this form, you will receive an email asking you to confirm your registration.  You MUST confirm your registration, otherwise; you will not gain access to finish and submit your application.

The login information you create is case sensitive.

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Create your Login Information
   

Email:
Note:  This serves as your username.

 *

Password:
At least 8 characters long.
Contain 4 unique characters.
Contain 2 digits or symbols

 *
Re-enter password:
 *
   
Name Information
   
First Name:  *
Middle Name:
Last Name:  *
Suffix (Jr., II etc...):
Maiden Name:
   
Background Information
   
Date of Birth:    Click Here to Pick up the date *
Gender (M)ale - (F)emale: F  *
Which of the following best describe your race? (you may mark more than one)
 American Indian or Alaska Native
 Asian
 Black or African-American
 Native Hawaiian or Other Pacific Islander
 Spanish/Hispanic/Latino/Latina
 White
 *
Is English your primary language? No Yes  *
What is the type of geographic area where you were raised?  *
   
Phone & Current Address Information
   
Day Time Phone:  *
Address:  *
City:  *
State/Province:  *
Postal Code:  *
Country:  *
   
Permanent Address Information
   
Address:  *
City:  *
State/Province:  *
Postal Code:  *
Country:  *
   
PA Program Registration Information
   
How did you learn about the PA Program at UC?
(you may mark more than one)
 
 Facebook
 From a Friend
 Direct Mail
 Program Website
 School Counselor
 Physician Assistant Education Association
 PhysicianAssistantED.com
 Other
 *
   
If you selected OTHER, please tell us how you learned about the PA Program:
   
Are you currently a University of Charleston student without a Bachelor's degree?  *
Admissions Pathway you are applying for:
   PA Fastrack for UC Students
   Direct Admission
 *
CASPA ID (Central Application Service for Physician Assistants)   *
Have you previously attended a physician assistant program or medical school? No Yes  *
Provide a detailed explanation for why you did not complete the training for the physician assistant program or medical school you previously attended.
Important Information for PA Program Applicants

In an effort to help those interested make a fully informed decision about applying to and matriculating into the University of Charleston Physician Assistant Program (UCPAP), we have included the links below to inform you relative to the corresponding information listed.

By checking this box, I hereby acknowledge that the information indicated in the above list has been made available to me.
Initials:  *
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For questions about the application and/or application process, please contact Pam Carden, Admissions Coordinator at 304-357-4968 or pamcarden@ucwv.edu.


Have a technical question or need technical help? Please contact the Web Administrator at 304-357-4842 or careysadowski@ucwv.edu.
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