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Language Proficiency
Select your first language (the language of your birth). If you speak additional languages, click Add Another Language. Then, select the language(s) and the level of your proficiency in each.
License Infraction
Indicate whether you have ever had any certification, registration, license, or clinical privileges revoked, suspended, or in any way restricted by an institution, state, or locality. If yes, enter an explanation in the spaces provided.
Academic Infraction
Indicate whether you have ever been disciplined or placed on academic probation while attending an academic institution. If you select Yes, enter a brief explanation in the field provided. Include:
- A brief description of the incident
- Specific charge made
- Related dates
- Consequence
- A reflection on the incident and how the incident has impacted your life.
Criminal History
Indicate your understanding of and agreement with the Criminal History statement.
Background Information
Programs fully recognize the importance of diversity in their student body and in the workforce. Accordingly, programs strongly encourage applications from persons from all socioeconomic, racial, ethnic, religious, and educational backgrounds and persons from groups underrepresented in the industry. Select any and all of the options in this section which you feel best apply to you. Please note that CASPA uses this section for statistical purposes only and it in no way affects your application or financial aid eligibility.
Low Income Levels Guidelines
If applicable, use the following chart to help you determine if you come from an economically disadvantaged background.
|
Size of Family* |
Income Level** |
|---|---|
|
1 |
$30,120 |
|
2 |
$40,880 |
|
3 |
$51,640 |
|
4 |
$62,400 |
|
5 |
$73,160 |
|
6 |
$83,920 |
|
7 |
$94,680 |
|
8 |
$105,440 |
|
For each additional person, add: |
$10,760 |
The low income level is based on 200 percent of the U.S. Department of Health and Human Services poverty guidelines. It is used to determine what constitutes a low-income family for the purposes of the SDS and LDS programs.
* Size of family means the number of exemptions listed on the qualified income tax return forms. For example, a family size of 4 may include two parents and two dependents.
** Income Level refers to the adjusted gross income stated on the federal income tax return 1040.
Additional Questions
Select your answers to any additional questions. Answering these questions helps programs gather information to develop future recruitment strategies.
COVID-19
Use this section to describe how the COVID-19 pandemic impacted your pathway to becoming a physician assistant. The questions listed in the application can help you get started, but you do not need to limit your responses to only these considerations.
Life Experiences
Explain how your life experiences and/or perspectives could contribute to the PA profession. How can these experiences help advance the goal of having healthcare providers who reflect the population of the country? You can enter up to 2,500 characters.