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.
If you have US military experience, select your anticipated status at the time of enrollment from the drop-down. Select Not a member of the military if this does not apply.
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.
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
- A reflection on the incident and how the incident has impacted your life.
NCOPE Accredited Residency Qualifier
Indicate whether your accredited residency position resides in select states.
Misdemeanor and Felony Convictions
Indicate whether you've ever been convicted of a misdemeanor or felony. Failure to disclose and provide accurate information about prior convictions may have serious consequences, such as annulment of acceptance offers, program dismissal, or other sanctions.
Be aware of the potential impact on program acceptance. Contact the programs you wish to apply to for advice if you have a felony conviction or a criminal record. If you are uncertain of the status of a charge versus a conviction on your record, or if you are uncertain as to whether your offense was an infraction, misdemeanor, or a felony, contact the city, county, or state jurisdiction where the incident occurred.
If you are convicted of a misdemeanor or felony prior to admission and/or matriculation, it is your responsibility to immediately inform your program(s).