Lonas Campus - Knoxville
Physical Therapist Assistant Program
Applicant Information Packet
Mission Statement
The mission of the South College PTA Program is to develop knowledgeable, motivated, competent
professionals who have the skills necessary to meet the career demands of an entry-level physical therapist
assistant and, thereby, serve the diverse needs of their communities. A comprehensive curriculum is
maintained, which includes verifying the competence and professionalism of our students. To promote an
optimal educational experience for all students, diversity in teaching methodology is also practiced. As role
models those involved with the program strive to exhibit the professional attributes expected in the physical
therapy profession.
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Content
Title of Information
Welcome Letter
General PTA Information – Role, Licensure, Career Opportunities
Overview of Program
Non-discrimination Statements
Advising Information
Accreditation
Admissions Requirements/Process
Curriculum Outline
Program Expenses & Scholarship Opportunities
Program Goals & Outcomes
Program Grading Policy
Special Graduation Requirements
Voluntary Withdrawal from program
Termination from program
Program Reapplication & Reinstatement
Admissions Materials
Admissions Checklist
Application
Applicant Reference Forms 1,2,3
Observation Requirements
Observation Form
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Lonas Campus - Knoxville
Dear Student:
The PTA Program faculty members welcome you to South College-Knoxville. South College-Knoxville
faculty members are committed to providing a quality educational experience that produces competent,
professional Physical Therapist Assistants who become important assets to the medical community.
In order to begin the major physical therapist assistant courses, you must successfully complete the admissions
process, meet certain admissions criteria, and be accepted into the program. This packet details the
requirements for application to the program and the criteria for admission. The student is responsible for seeing
that he/she has met all application requirements and submitted them to one of the program’s advisors. I
recommend you print out the Admissions Checklist and initial off each part as you read through the packet to
ensure full understanding.
Again, welcome to South College-Knoxville. We will be meeting periodically, but please contact met at any
time with your questions or needs.
Sincerely,
Kelly Nash, PT, MS
Kelly Nash, PT, MS
Chair, PTA Program
South College-Knoxville
3904 Lonas Drive
Knoxville, TN 37909
Ph: (865) 251-1839
Fax: (865) 584-9816
[email protected]
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Role of the Physical Therapist Assistant in Health Care Delivery
The physical therapist assistant (PTA) is a technically educated health provider who assists the physical
therapist (PT) in the provision of physical therapy. The PTA is a graduate of a physical therapist assistant
associate degree program accredited by the Commission on Accreditation in Physical Therapy Education
(CAPTE). The PTA works under the direction and supervision of the PT, helping manage conditions such as
back and neck injuries, sprains/strains, fractures, arthritis, burns, amputations, stroke, multiple sclerosis, birth
defects, injuries related to work and sports, and others. (Taken in part from the American Physical Therapy
Association, 2000)
Physical Therapist Assistant Licensure
Passing a national licensing examination administered by the Federation of State Boards of Physical Therapy
(FSBPT) is a requirement for professional practice in the state of Tennessee. Specific information regarding
application for licensure will be available to students during their last term of enrollment. Licensure is now
required in every state for the physical therapist assistant to practice. Complete information on practice acts and
regulations can be obtained from individual state licensing boards.
Career Opportunities
Search the following websites to view career opportunities as a physical therapist assistant: www.apta.org and
www.tptaonline.org .
Overview of the Physical Therapist Assistant Program
The Physical Therapist Assistant program offered at the South College Lonas Campus in Knoxville is a 24month program leading to an Associate of Science degree. The prerequisite general education courses are
available in the mornings, afternoons, and evenings, Monday through Saturday. The major curriculum courses
are typically taught in the mornings and afternoons, Monday through Fridays. Class schedules may change at
the discretion of the institution. Students should be committed to considerable out of classroom
preparation and study. Certain methods classes require off-campus site attendance.
Major curriculum classes are taken in a specified order to allow the student to build upon basic information each
quarter. Full-time attendance is required during this portion of the program. See the PTA Curriculum Outline
on subsequent page.
Clinical education internships are required and administered by South College and take place in a variety of
health care delivery facilities in the Knoxville metropolitan area and beyond. Students will be assigned to a
clinic for each experience. During each experience, the student will work with clients under the supervision of
a staff member of the facility. This person is known as the Clinical Instructor (CI). Students are responsible for
their own transportation to and from these off campus education sites. The program makes all attempts to
assign students to clinical sites within 1 ½ hour of the college. Students are expected to work a specified
number of hours each week with the number of hours each day determined in part by the work hours of the CI.
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A variety of clinical experiences is required while in the program. Students are responsible for costs associated
with any emergency services needed while participating in off-site educational activities. Failure to produce
proof of the following may severely limit fieldwork placement and future employment options:
 Negative TB test
 Hepatitis B vaccination or waiver
 Health release to participate in clinical internships/physician’s certification that student is in good general
health
 Other immunization, such as MMR
 Current CPR training
 Criminal background check
Students applying to the Physical Therapist Assistant program should also be aware that a felony conviction of
any type may affect his/her ability to attain state licensure. Applicants must also be able to demonstrate basic
functional capacities required in the field of physical therapy (refer to college catalog for specifics) with
reasonable accommodations if needed.
South College is an equal opportunity college open to any qualified individual without regard to race, religion,
sex, age, color, national or ethnic origin, or disability. Pursuant to all applicable federal anti-discrimination
laws and regulations, South College does not discriminate against any of the protected categories of individuals
in the administration of policies, programs, or activities. This non-discriminatory policy includes admission
policies, loan programs, employment practices, and all other college-administered programs.
South College does not discriminate on the bases of disability and is committed to full compliance with the
American with Disabilities Act (ADA) of 1990.
There are several options related to health care offered at the South College Lonas Campus in Knoxville. In the
event that a student is not accepted into the physical therapist assist program, he/she may be eligible to apply to
one of these health care programs. The PTA program’s advisors are available to meet with students to discuss
possible career options. Below are the names and contact information for the program’s advisors. Their offices
are located on the second floor of the Lonas campus in the faculty office area.
Denise Griffin, PT, PTA Program ACCE
[email protected]
(865) 251-1840
or
Kelly Nash, PT, PTA Department Chair
[email protected]
(865) 251-1839
Accreditation
The Physical Therapist Assistant program offered at the South College Lonas Campus in Knoxville has
received full programmatic accreditation from the Commission of Accreditation in Physical Therapy Education
(CAPTE) through the year 2023.
The Commission on Accreditation in Physical Therapy Education
1111 North Fairfax Street, Alexandria, VA 22314
Telephone: 703-706-3245
E-mail: [email protected] Website: www.capteonline.org
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South College Lonas Campus in Knoxville
PTA Program Admissions Requirements/Process
1.
2.
3.
4.
All steps must be completed for acceptance.
Apply to South College following the general admissions procedures outlined in the South College catalog. This
includes completion of the application and all other required forms, payment of an application fee, and completion of
a personal interview with an admissions representative.
Meet at least one of the following admissions requirements:
 Complete and earn the minimum scores required by the PTA program on all sections of the college administered
admissions examination.
 Provide proof of an ACT score of 19 or better.
 Provide proof of a combined score of 900 or higher on the SAT I exam.
 Have earned transfer credit of either 18 semester or 27 quarter hours with at least a 3.0 GPA (determined by
Executive Vice President/Registrar and/or program’s chairperson). Students may not take major curriculum
courses until transcripts have been received to verify pre-requisites have been completed.
 Achieve a GPA of at least 3.00 for the pre-requisite general education courses.
Start taking pre-requisite general education courses. The PTA program requires a grade of “C” or higher in all
required general education core courses.
 Complete BIO 1110 Anatomy & Physiology I, BIO 1120 Anatomy & Physiology I Lab, BIO 1130 Anatomy &
Physiology II, and BIO 1140 Anatomy & Physiology II Lab with at least a 2.50 GPA. The necessary grades
must be achieved on the first or second attempt (all postsecondary attempts counted) unless approved by
department chair
While taking the pre-requisite courses, complete and submit the following admissions materials to a program advisor:
 PTA Applicant Checklist
 South College Lonas Campus in Knoxville PTA Program Application
 Three (3) references, from appropriate sources (no family OR faculty/staff of South College Lonas Campus in
Knoxville), using the forms provided. Applicants must achieve a 75% average for the references.
 Proof of at least 24 volunteer or work hours spent observing physical therapists and/or physical therapist
assistants treating patients in a clinical setting using the form provided in this packet.
The physical therapist assistant faculty members will begin reviewing all admission materials on February 20th for
Spring Quarter admission and on August 15th for Fall Quarter admission to the PTA program. Any student
currently enrolled in South College-Knoxville or who has met with the program faculty to review the application
packet at least four weeks prior to these dates must submit materials by this deadline. Any new applications to the
program after the deadline dates will be considered case by case depending upon remaining seat availability for the
cohort.
5. Completing steps 1-4 makes you a “candidate” for the program and qualifies you to take the first quarter of PTA
courses (PTA 1010 Introduction to PTA, PTA 1030 Pathophysiology, and PTA 1040 Kinesiology for the PTA). A
ranking system will be used to determine those candidates allowed to take the first quarter of PTA courses if more
than 24 students complete the admissions process by the deadlines noted above. Students may consult any advisor
regarding questions about the ranking system.
6. You must pass the first quarter of PTA courses with a “C” or better to be fully accepted into the South College PTA
program. Students may take the first quarter of PTA courses a maximum of two times.
Applicants will be officially notified of their “candidacy” status after all application information is received as well
as when they have been fully accepted into the program.
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PTA Curriculum Outline
The program is designed for completion in 8 quarters (2 years) for full-time students. PTA students normally attend
classes throughout the year, including the summer quarter, once in the major curriculum courses. The list below indicates
which classes should be taken in each quarter.
Courses in “BOLD” print must be completed prior to admission to PTA major courses. A psychology elective (PSY 1810
or PSY 1820), a humanities elective (see list of acceptable courses in college catalog), and College Mathematics I (MAT
1500) must be taken prior to graduation.
Prospective students transferring credit into the PTA program should consult with the PTA Department Chair regarding
transferability of credit. There is no guarantee that transfer credit will be given for major curriculum courses.
Quarter #/
Courses
Credit Hours
Contact Hours
Lecture/Lab
6
2 vs. 4
4/4
4
4
4
16-18 total
6
4
4
4
18 total
5
4
5
14 total
6
8
(4)
14-18 total
4
4
20
8
4
4
4
20 total
4/2
4
3/4
17 total
3/6
4/8
(4)
20-24 total
8
4
(4)
12-16 total
8
5
(4)
13-17 total
12
4/8
16 x 8
(4)
12-32 total
4/8
4/2
18 total
12
40
Quarters
Offered at
Lonas
1
All
2
All
3
Spring & Fall
4
Summer &
Winter
5
Spring & Fall
6
Summer &
Winter
7
Spring & Fall
8
Summer &
Winter
BIO 1110 & 1120 Anatomy & Physiology I Lecture and Lab
MAT 1000 Mathematical Concepts & Foundations (if required) vs.
MAT 1500 College Math I
ENG 1200 English Composition
AHS 1010 Medical Terminology
BIO 1130 & 1140 A & P II Lecture and Lab
MAT 1510 College Math II
ENG 1210 English Composition with Research
COM 1260 Effective Speaking
PTA 1010 Introduction to PTA
PTA 1030 Pathophysiology
PTA 1040 Kinesiology for the PTA
Incurred cost for: Criminal Background Check
PTA 1080 Modalities
PTA 2000 Habilitation/Rehabilitation
And one of the following if not taken prior: Approved Psychology
or Humanities Elective or College Math I
Program Fee: CPR Incurred cost for: Physical Exam/Shots
PTA 2200 Exercise Therapy & Muscle Testing
PTA 2420 Clinical Education I [2 days(16 hrs)/week for 8 weeks]
And one of the following if not taken prior: Approved Psychology
or Humanities Elective or College Math I
PTA 2460 Advanced Habilitation/Rehabilitation
PTA 2510 Special Topics in PT
And one of the following if not taken prior: Approved Psychology
or Humanities Elective or College Math I
PTA 2525 Clinical Education II
40
(Internship A = 40hrs./week for 4 weeks then 8 hrs. classroom then Internship B
= 40 hrs./week for 5 weeks)
Program Fee: Licensure Exam Study Guide & Prep Course
PTA 2535 Clinical Education III
(Internship = 40 hrs./week for 6 weeks then 40 hrs. classroom over 4 weeks)
“Contact Hours” means the number of hours per week the student will be in the classroom or other education setting. The
student should expect to spend as much as three times the weekly contact hours in study and preparation.
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PTA Program Expenses
The purpose of the following information is to provide the student with approximate program expenses that will be
incurred, in addition to college tuition, in order to complete the physical therapist assistant program and become licensed
to practice as a PTA. Every effort has been made to identify all major costs. These costs are only an approximation in
many cases and are subject to change.
Items
Liability Insurance for Clinical Rotations
Programmatic Fees
Cost
College provides at no cost to student
Mandatory programmatic fees will be applied to each student’s cost of
attending during the 4th and 7th quarters of the program. The fee for the
4th quarter covers the cost for CPR training, which is required for clinical
participation. The fee for the 7th quarter covers the cost for the PTA
licensure exam study guide provided to the student at the start of the
quarter and the subsequent one day preparatory course required by the
program. These costs may be covered by Financial Aid.
CPR training thru college = $40
Licensure exam prep = $210
Incurred Expenses
These expenses are required, but are not covered by Financial Aid.
Qu. 3: Criminal Background Check $37.50
Qu. 4: Physical Exam/Immunizations Varied cost
Some clinical sites may require drug screening. Varied cost ($50)
Medical Insurance & Health Care Expenses
Medical insurance is not required, but is recommended since students are
responsible for the cost of any medical services, including emergency
care, while a student at South College-Knoxville and while on clinical
assignments as a student of the college.
Supplies - Recommended, but not required.
Goniometer
Watch with a second hand
Lanyard and ID holder
Scrubs or other attire for clinicals
School-related fees & costs
Application fee
Graduation fee
Textbooks
Technology fee
Licensure Fees
Exam fees to Prometrics
Licensure cost in TN
Varied cost
Varied cost depending on size (up to $25)
Varied cost ($10+)
Varied cost ($10+)
Varied cost ($100)
$50
$200
$400 (average cost/quarter)
$125 per quarter
$470
$75 (possible extra cost for criminal background check)
Scholarship Opportunities
Minority scholarships are awarded through the American Physical Therapy Association. Go to www.apta.org
and search minority scholarships for application and other information including a list of links to additional aid
and grant resources. For other possible scholarships, please meet with a Financial Aid representative.
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PTA Program Goals & Expected Outcomes
1. Graduates will be competent physical therapist assistants who work under the supervision of physical
therapists.
a. Students/graduates will demonstrate effective written and oral communication skills.
b. Students/graduates will implement appropriate physical therapy treatments based on the plan of care
established by a licensed physical therapist.
c. Students/graduates will understand the role of the physical therapist assistant and work in a manner
consistent with their state practice act and APTA’s Code of Ethics and Guide for Conduct of the
Physical Therapist Assistant.
d. Students/graduates will produce graduates who pass the national physical therapist assistant licensure
exam.
2. The program will maintain a comprehensive curriculum developed and taught by qualified faculty in
accordance with accreditation standards.
a. Faculty will continually develop and improve a comprehensive didactic curriculum.
b. Faculty who continually develop and improve a comprehensive clinical education plan.
c. The program will maintain adequate physical and monetary resources to facilitate a learning
environment.
d. The program’s mission, philosophy, goals, and objectives will be consistent with those of the college.
3. The program, through its faculty and students, will show a commitment to the private and professional
communities through activities of continuing education, service, and advocacy for the physical therapy
profession.
a. The program will provide faculty with professional development opportunities relevant to their topics of
instruction, licensure requirements, areas of weakness noted on assessment tools, and desired areas of
professional growth.
b. Faculty and students will participate in community service activities.
c. Faculty will be advocates for the physical therapy profession.
PTA Program Grading System
A.
8-point Grading Scale
The physical therapist assistant program utilizes an 8-point grading scale in all its major curriculum courses:
Letter Grade
10-pt Grading System
8-pt. Grading System
A
90.00+%
92.00+%
B
80.00-89.99%
83.00 – 91.99%
C
70.00-79.99%
75.00 – 82.99%
D
60.00-69.99%
68.00 – 74.99%
F
<60.00%
<68.00%
In the PTA program we do NOT round up point grades.
B.
Test Average & Overall Course Score
Students are required to earn a minimum test average in all PTA major curriculum courses in order to pass a
course. This test average is calculated based on written exams taken during the 10-week quarter and the final
exam, weighted equally, as well as quizzes based on lab activities (depending on the course). The minimum
test average required is 70.00% in the first quarter of PTA courses, then it increases to 75.00% once fully
accepted into the program.
Page 9 of 25
Students are also required to earn a minimum overall course score of 75% in all PTA major curriculum courses
(including the first quarter) to pass a course and thus progress in the program. This grade is calculated based on
all grading criteria listed in each course syllabus.
 IF a student achieves a test average below the minimum requirement, the course grade (A-F) will equal the
numerical value of the test average. Other class activities such as written assignments, attendance, and
programmatic paperwork will NOT be considered in the final grade. In the first quarter of PTA courses the
percentage values associated with a 10-pt. system (noted above) will be used while subsequent quarters will
use those associated with an 8-pt. system.
 IF a student achieves a test average above the minimum requirement, all class activities and paperwork will
be used to determine the final grade using the point system noted in each syllabus. The 8-pt. system noted
above will be used for all major curriculum courses.
Special Requirements to Graduate from the PTA Program
Besides paying a graduation fee to cover the cost of graduation, the college and/or the PTA program requires its
student to complete certain tasks in order to graduate. These activities are completed during the 40 hours of
classroom activities associated with PTA 2535. The focus of this class time is ensuring that students are ready
to obtain licensure and practice as a physical therapist assistant.
A.
Portfolio
As part of the college’s Writing Across the Curriculum (WAC) program, students are required to submit written
assignments done in various general education courses as well as PTA 2460 to be included in a portfolio. The
college requires that each student’s portfolio be assessed for completeness by a representative from the WAC
program in their last quarter of attendance. If a student’s portfolio is not cleared, the college may not release the
student’s transcript to the state thus preventing them from obtaining licensure to practice in a timely fashion.
B.
Outcomes Assessment Exam
The PTA program requires all PTA majors to pass an Outcomes Assessment Exam (OAE) in order to ensure
students are prepared to pass the licensure exam and practice as a physical therapist assistant. This exam is
taken on-line through a company that specializes in providing such exams. The cost for this exam is borne by
the college.
C.
Resume & Interview Preparation
Students will meet several times with the college’s Placement Coordinator to perfect their resume, help them
prepare for job interviews, and to help them locate possible employers.
Voluntary Withdrawal
If a student voluntarily withdraws from the PTA program, there will be no guarantee that he/she will be readmitted. Re-admission will be based on student ranking and space availability if the withdrawal occurred
before or during the first quarter of PTA classes and on results of the reinstatement process if withdrawal
occurred during or after full acceptance into the program. Before withdrawing from any class, the PTA student
should see the PTA Department Chair to determine the best course of action, since withdrawing may interrupt
or stop continued education in the PTA program.
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Termination from the PTA Program
Grounds for termination from the PTA Program include the following:
 Insufficient academic progress (making below a “C” in a major curriculum course).
 Nonpayment of costs
 Failure to comply with rules and/or Standards of Ethical Conduct
 Falsification of application to the college or the program.
 Unsafe or unethical clinical behavior.
Any student wishing to be readmitted to the program must contact the Department Chair, who will then initiate
either a reapplication process or a reinstatement process depending on the quarter the termination occurred in.
Reapplication Process
If a student does not complete or pass one or more of the first quarter of PTA classes, he/she does not qualify
for “Full” acceptance into the program. A reapplication process must then occur. If their application is over
one year old, the student will have to start the entire application process over from the beginning. If it is less
than one year old, the student must send written confirmation of their desire to return by the deadline prior to
the start of the quarter they intend to retake the classes as well as doing 24 more hours of observation. There
will be no guarantee that he/she will be re-admitted. Re-admission will be based on student ranking and space
availability. Unless there are mitigating circumstances, only one re-application will be allowed.
PTA Reinstatement Policy
Once “fully” accepted, a student may be dismissed from the South College Lonas Campus in Knoxville PTA
program due to insufficient academic progress (failure to score a “C” or better in a major specialty class),
nonpayment of costs, failure to comply with the rules and/or the code of conduct, non-adherence to the
attendance policy, falsification of application to the college, or unsafe, unethical or unprofessional clinical
behavior. The student must then be reinstated into the program if he/she wishes to continue.
The following restrictions apply to reinstatement:
1.
The student may not be reinstated into the PTA program more than once, unless extreme mitigating
circumstances exist and are documented.
2.
If a student is dismissed from the South College PTA program for failing to score a “C’ or better in a
major specialty class, the student must score a “B” or better in the class/es if reinstatement is granted.
3.
The student must pass a practical exam that covers all content from courses he/she passed previously in
order to verify maintenance of skills. A score of “C” or better is required to pass.
4.
If the student wishes to delay reinstatement, he/she may do so for up to 1 year maximum.
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Application
Materials
All forms to be submitted to a PTA Program Advisor
Page 12 of 25
PTA Applicant Checklist for Lonas Campus in Knoxville
Name ___________________________________________________________________________________
(print)
Applicants are to initial each item and sign on the signature line to indicate understanding of the program
admission process. Submit completed form to a program advisor to begin the application process.
1.
________
2.
________
3.
________
4.
________
5.
________
6.
________
7.
________
8.
________
9.
________
10. ________
11. ________
12. ________
13. ________
14. ________
15. ________
16. ________
I am aware that once I start the PTA major curriculum I must be a full-time student and attend classes year round.
I am aware that the PTA major curriculum courses are typically offered during the day and require significant
out-of-class preparation time.
I am aware that during my clinical experiences I will be working under the supervision of a Clinical Instructor (CI)
at the facility I am assigned to and that I am expected to work whatever hours the CI does while I am there. I
understand that I am responsible for transportation during clinical experiences and that travel time can be up to 90
minutes from the college.
I am aware that the results of my Criminal Background Check and possibly Drug Screening can result in a
clinical facility denying my participation in a clinical experience. This may result in failure of a course and
dismissal from the program. I understand that during a clinical experience I will be held to the policies and
procedures of the facility including those related to drug testing.
I know that the advisors for the Physical Therapist Assistant program have offices located at the Lonas Campus in
Knoxville. I know that I must meet with him/her at least once a quarter for advising.
I have received the Physical Therapist Assistant Program’s Applicant Information Packet including the admission
process information. I am aware that I must complete this process in order to be considered for acceptance into
the PTA program.
I am aware that I must apply to the PTA Program after applying to the college in general.
I am aware that I must meet or exceed the minimum score required by the PTA Program on the college entrance
examination OR the minimum score on the ACT or SAT OR achieve a sufficient GPA in the pre-requisite general
education courses OR the transfer hours and criteria as outlined in the Applicant Packet to be considered for
acceptance into the PTA program.
I am aware that I must make a C or higher in all of the required general education courses and all of my PTA
Major Curriculum courses. I must provide copies of transcripts from other schools where I have taken any prerequisite general education courses before I will be allowed to take any of the PTA major curriculum courses in
order to confirm I have met the above grade requirements.
I am aware that I must achieve a GPA of at least 2.5/4.0 in my A&P courses to qualify to take the PTA Major
Curriculum courses.
I know that I must provide 3 letters of recommendation using the form provided by the program. I understand that
these are not to come from faculty or staff members of South College Lonas Campus in Knoxville OR from family
members. I know that these are scored and I must achieve a 75% average for acceptance into the PTA program.
I am aware that I must provide proof of at least 24 observation/volunteer/ work hours in physical therapy settings
using the form provided by the PTA program.
I am aware that programs fees for CPR and a licensure exam preparation course will be required during the major
curriculum courses. Other fees may also be incurred in order to ensure preparation for clinical experiences, but will
not be paid for by financial aid money.
I am aware that I must achieve a specified test average to pass each PTA Major Curriculum course. I am aware
that the PTA major curriculum courses utilize an 8-point grading scale.
I am aware that I will be required to submit assignments to a writing portfolio and that the portfolio must be
completed in order to graduate from South College Lonas Campus in Knoxville.
I am aware that I must pass the Outcomes Assessment Exam approved by the program faculty in order to graduate
from South College Lonas Campus in Knoxville.
I am aware that I must reapply/reinstate into the program if I voluntarily withdraw or I do not make a C or higher in
any of the PTA major curriculum courses and that reapplication/ reinstatement is not guaranteed. I am aware that I
can be terminated from the program at any time for unsafe or unprofessional behavior.
Student Signature _____________________________________________________
Page 13 of 25
Date _____________________________
South College Lonas Campus in Knoxville
Physical Therapist Assistant Program Application
Complete and submit to a PTA Program Advisor to begin the application process.
Name ____________________________________________________________
First
Middle
Maiden
Last
Date _________________
Address __________________________________________________________
Street # & Name
Apt. #
DOB _________________
___________________________________________________
City
State
Zip
SSN ________________________
Home Telephone ________________________________ Cell Telephone ________________________________
Email _______________________________________________________________________________________
-------------------------------------------------------------------------------------------------------------------------------------------Education
High School Attended:
_____________________________________________________________________________________________
Name
City
State
Graduation Date
If not a high school graduate, do you a hold a GED Certificate? Yes
If yes, Date of GED Certificate _________________________
College(s) Attended:
Name
City
State
No
Attendance Dates
Degree Received
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Have you ever applied to or been accepted/attended a PTA program at another college or university? Circle one:
Yes
No
If “yes”, name of school & dates attended: _____________________________________________
Reason(s) for leaving? ___________________________________________________________________________
OVER
Program Use Only
SC Admission
_________
Reference Avg. Score
__________
Program Start
__________
__________
ACT/SAT _______ Tr.Cr.________
Observation Verification __________
Admission Date
Transcripts Received
Pre-Req. GPA
__________
Reapplication/Reinstatement?
A&P GPA
__________
Graduation Date
_________
Math _____ Read _____ Sent _____
Page 14 of 25
_________
Programmatic Issues
To ensure a safe environment, PTA students must be able to demonstrate certain functional capacities (refer to college
catalog for specifics) as well as demonstrate emotional fitness. Any appraisal measures used will be in compliance with
Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990.
Do you have a physical or mental health condition that could cause you or any other person to be placed in danger
if admitted to the program? Circle one:
Yes
No
If yes, please explain ______________________________________________________________________________
________________________________________________________________________________________________
Have you ever been convicted or under litigation for a misdemeanor or felony? Circle one:
Yes
No
Dispensation of case ______________________________________________________________________________
_______________________________________________________________________________________________
An affirmative answer will not necessarily bar admission; however, a student with a “yes” answer is advised to consult
with the accrediting licensure board regarding eligibility before entering the PTA program.
Work History: List your past employment (for the past 5 yrs.) in the space below providing years worked at each place
when possible.
On the following page, please include a brief (1-2 paragraph), hand-written summary about the reason why you want to
become a physical therapist assistant (PTA) AND give at least three (3) attributes you will bring to the physical therapy
profession. This provides the program evidence of your ability to communicate in written form at a collegiate level as
well as giving insight into your understanding of the field of physical therapy and the role of the PTA. Be sure to use
proper grammar, punctuation, and check spelling.
Page 15 of 25
Written Summary
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Continue on separate page if more space is needed
I affirm that all statements on this form are true and accurate.
Signature _______________________________________________________ Date __________________________
Page 16 of 25
South College Lonas Campus in Knoxville
Physical Therapist Assistant Program
Reference Form #1
I ________________________________, an applicant for the Physical Therapist Assistant Program at
(Applicant SIGNATURE)
South College Lonas Campus in Knoxville, waive my right to view any reference information contained on this
form.
Please complete this form evaluating ___________________________________’s general ability and
( PRINT Applicant Name)
potential to be a successful college student and future healthcare professional.
Note: Your reference will be scored, averaged with other references, and used to determine the eligibility of
the applicant for the PTA program. Only if the applicant signed the above statement can the content
of your reference be treated as confidential by South College Lonas Campus in Knoxville.
Name of person completing reference: _________________________________________________________
Position: ________________________________________________________________________________
May we call you if necessary?
Yes _____
No _____
Work Number: (____) ______________________ Home Number: (____) __________________________
Signature of Reference: __________________________________________ Date: _________________
Once you have filled out this form please place it in an envelope, seal the envelope, and then sign your name
over the seal to ensure confidentiality. If you were not given an envelope, please return this form to:
South College, Lonas Campus
3904 Lonas Road
Knoxville, TN 37909
Attn: PTA Program
1.a.
Please describe your relationship with the applicant. Be specific (teacher/staff from another institution,
employer, supervisor, advisor, counselor, manager, minister, co-worker, etc.). Family members are
not appropriate for references.
___________________________________________________________________________________
___________________________________________________________________________________
b.
How long have you known the applicant? ________________________________________________
To be completed by PTA Program Representative: Appropriate reference source:
Yes No
Page 17 of 25
2.
How knowledgeable do you consider yourself to be about the applicant? Circle the appropriate number.
Limited Knowledge
Extensive Knowledge
1
3.
2
3
4
5
6
7
8
9
10
Please rate the applicant in the areas listed below in relation to the setting in which you have worked
with the applicant.
Poor
Below
Average
2
1
Average
Above
Average
4
3
Exceptional
5
No Basis for
Judgment
0
Written Communication
Oral Communication
Problem Solving
Sense of Responsibility
Professional Behavior
Professional Appearance
Service to Community
Keeping Commitments
Teaching Ability
Sense of Ethics
Regard for Safety
4.
Based on your knowledge of this applicant’s abilities, how would you rate the applicant’s potential for
success in an intense, fast-paced, college level program? Circle the appropriate number
Limited Potential
Excellent Potential
1
5.
2
3
4
5
6
7
8
9
10
Based on your knowledge of this applicant’s professional and personal qualities, how would you rate
this person’s potential for professional success in healthcare?
Limited Potential
Excellent Potential
1
2
3
4
5
6
7
8
9
10
6.
Please add any additional comments pertinent to this person’s academic and intellectual abilities.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Page 18 of 25
South College Lonas Campus in Knoxville
Physical Therapist Assistant Program
Reference Form #2
I ________________________________, an applicant for the Physical Therapist Assistant Program at
(Applicant SIGNATURE)
South College Lonas Campus in Knoxville, waive my right to view any reference information contained on this
form.
Please complete this form evaluating ___________________________________’s general ability and
( PRINT Applicant Name)
potential to be a successful college student and future healthcare professional.
Note: Your reference will be scored, averaged with other references, and used to determine the eligibility of
the applicant for the PTA program. Only if the applicant signed the above statement can the content
of your reference be treated as confidential by South College Lonas Campus in Knoxville.
Name of person completing reference: _________________________________________________________
Position: ________________________________________________________________________________
May we call you if necessary?
Yes _____
No _____
Work Number: (____) ______________________ Home Number: (____) __________________________
Signature of Reference: __________________________________________ Date: _________________
Once you have filled out this form please place it in an envelope, seal the envelope, and then sign your name
over the seal to ensure confidentiality. If you were not given an envelope, please return this form to:
South College Lonas Campus
3904 Lonas Road
Knoxville, TN 37909
Attn: PTA Program
1.a.
Please describe your relationship with the applicant. Be specific (teacher/staff from another institution,
employer, supervisor, advisor, counselor, manager, minister, co-worker, etc.). Family members are
not appropriate for references.
___________________________________________________________________________________
___________________________________________________________________________________
b.
How long have you known the applicant? ________________________________________________
To be completed by PTA Program Representative: Appropriate reference source:
Yes No
Page 19 of 25
2.
How knowledgeable do you consider yourself to be about the applicant? Circle the appropriate number.
Limited Knowledge
Extensive Knowledge
1
3.
2
3
4
5
6
7
8
9
10
Please rate the applicant in the areas listed below in relation to the setting in which you have worked
with the applicant.
Poor
Below
Average
2
1
Average
Above
Average
4
3
Exceptional
5
No Basis for
Judgment
0
Written Communication
Oral Communication
Problem Solving
Sense of Responsibility
Professional Behavior
Professional Appearance
Service to Community
Keeping Commitments
Teaching Ability
Sense of Ethics
Regard for Safety
4.
Based on your knowledge of this applicant’s abilities, how would you rate the applicant’s potential for
success in an intense, fast-paced, college level program? Circle the appropriate number
Limited Potential
Excellent Potential
1
5.
2
3
4
5
6
7
8
9
10
Based on your knowledge of this applicant’s professional and personal qualities, how would you rate
this person’s potential for professional success in healthcare?
Limited Potential
Excellent Potential
1
2
3
4
5
6
7
8
9
10
6.
Please add any additional comments pertinent to this person’s academic and intellectual abilities.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Page 20 of 25
South College Lonas Campus in Knoxville
Physical Therapist Assistant Program
Reference Form #3
I ________________________________, an applicant for the Physical Therapist Assistant Program at
(Applicant SIGNATURE)
South College Lonas Campus in Knoxville, waive my right to view any reference information contained on this
form.
Please complete this form evaluating ___________________________________’s general ability and
( PRINT Applicant Name)
potential to be a successful college student and future healthcare professional.
Note: Your reference will be scored, averaged with other references, and used to determine the eligibility of
the applicant for the PTA program. Only if the applicant signed the above statement can the content
of your reference be treated as confidential by South College Lonas Campus in Knoxville.
Name of person completing reference: _________________________________________________________
Position: ________________________________________________________________________________
May we call you if necessary?
Yes _____
No _____
Work Number: (____) ______________________ Home Number: (____) __________________________
Signature of Reference: __________________________________________ Date: _________________
Once you have filled out this form please place it in an envelope, seal the envelope, and then sign your name
over the seal to ensure confidentiality. If you were not given an envelope, please return this form to:
South College Lonas Campus
3904 Lonas Road
Knoxville, TN 37909
Attn: PTA Program
1.a.
Please describe your relationship with the applicant. Be specific (teacher/staff from another institution,
employer, supervisor, advisor, counselor, manager, minister, co-worker, etc.). Family members are
not appropriate for references.
___________________________________________________________________________________
___________________________________________________________________________________
b.
How long have you known the applicant? ________________________________________________
To be completed by PTA Program Representative: Appropriate reference source:
Yes No
Page 21 of 25
2.
How knowledgeable do you consider yourself to be about the applicant? Circle the appropriate number.
Limited Knowledge
Extensive Knowledge
1
3.
2
3
4
5
6
7
8
9
10
Please rate the applicant in the areas listed below in relation to the setting in which you have worked
with the applicant.
Poor
Below
Average
2
1
Average
Above
Average
4
3
Exceptional
5
No Basis for
Judgment
0
Written Communication
Oral Communication
Problem Solving
Sense of Responsibility
Professional Behavior
Professional Appearance
Service to Community
Keeping Commitments
Teaching Ability
Sense of Ethics
Regard for Safety
4.
Based on your knowledge of this applicant’s abilities, how would you rate the applicant’s potential for
success in an intense, fast-paced, college level program? Circle the appropriate number
Limited Potential
Excellent Potential
1
5.
2
3
4
5
6
7
8
9
10
Based on your knowledge of this applicant’s professional and personal qualities, how would you rate
this person’s potential for professional success in healthcare?
Limited Potential
Excellent Potential
1
2
3
4
5
6
7
8
9
10
6.
Please add any additional comments pertinent to this person’s academic and intellectual abilities.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Page 22 of 25
Instructions and Requirements for Observation Hours
1. Clinical facilities and clinicians are not required to have students observe nor are they reimbursed for
applicants observing them work. Applicants must realize that they are guests at the facility and must not be
a burden to the clinician or in any way interfere with patient care. Applicants are expected to dress
professionally in “business casual” attire.
2. A minimum of 24 hours of observation of a physical therapist (PT) or a physical therapist assistant (PTA)
working in physical therapy are required for application to the professional component of the program.
Those applicants that work as physical therapy technicians/aides can use their work experience for this
requirement. The more hours that are done, the more points an applicant can achieve on the ranking system.
3. It is recommended that applicants observe at two different types of facilities in order to ensure a broad
experience regarding the interventions provided by PTs and PTAs. Examples of different types of facilities
include hospitals, out-patient clinics, and skilled nursing facilities. Do NOT observe at a chiropractic office
UNLESS they employ licensed physical therapy personnel, which is who should be observed.
4. Make copies of the observation form pages so that each different observation experience is recorded
on a separate form.
Page 23 of 25
South College Lonas Campus in Knoxville PTA Program
Observation of Physical Therapy
Verification Form
Complete one form for EACH facility. Submit this form to a PTA Program Advisor.
Dear Physical Therapy Practitioner,
We believe that it is important for prospective students to gain some knowledge of the field of physical therapy
before making a commitment to a demanding educational program. Therefore, our program has included an
observation requirement for all students. A requirement of 24 or more hours of observation or paid work as an
aide/tech must be fulfilled to be considered for acceptance into our PTA program. These hours must be in a
setting where physical therapy services are provided. Students must observe either a physical therapist or a
physical therapist assistant during their time at your clinic. The primary objective is for the student to get
exposure to the practice of physical therapy and develop a better understanding of the profession.
Once the student has completed his/her experience with your clinic, please fill out the information below and
return this form to the student. Please do not sign the form until the student has completed the total
number of hours scheduled at your clinic. If you have any questions, please call Denise Griffin, PT at 2511840, or Kelly Nash, PT at (865) 251-1839. Thank you for your willingness to support our students and
applicants.
To be filled out by the practitioner:
Student’s Name ____________________________________________________________________________
Name of Facility ___________________________________________________________________________
Type of Facility ___________________________________________________________________________
Total number of hours completed in your clinic/department _______________
(The table below can be used to track the total hours if all were not done on same day)
Practitioner Name & Title ________________________________________
Printed
________________________________________ Date _______________
Signature
Date
Start
Time
End Time
Total
Time
Date
Page 24 of 25
Start
Time
End
Time
Total
Time
Physical Therapy Observation Verification (cont.)
To be filled out by the student:
1.
What types of patients did you observe (diagnoses, limitations, physical problems)?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2.
What did you find most interesting/significant about what you observed?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3.
What interested you least during your hours of observation?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
4.
How was your overall experience?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Page 25 of 25