Thank you for your interest in our Physician Assistant Program. This

Dear Prospective Student:

Thank you for your interest in our Physician Assistant Program. This packet includes the

following documents:

o Instructions for Applying

o Degree Track Sheet

o Application for Admission Questionnaire

o Recommendation Forms (3)

o Instructions for Recommendation Writer

Click on the link below to view the Technical Standards for participating in

the Program: https://shp.rutgers.edu/admissions/rbhs-technical-standards/

The deadline for submitting applications and all supporting documents is June 1

You will receive an email notification when your application is received within 1

week of the program’s receipt. You are also welcome to call the PA program to

confirm receipt of your application.

Please contact this office at 732-235-4445 if any questions arise regarding your

application. Best wishes with your plans to become a physician assistant.

Sincerely,

Rutgers PA Program

Department of Physician Assistant Studies and Practice

Rutgers, The State University of New Jersey

675 Hoes Lane West, 6

floor

Piscataway, NJ 08854-5635

http://shp.rutgers.edu

p. 732-235-4445

f. 732-235-4820

2024-2024 Application Cycle

3+3 Application Instructions

I. COMPLETING YOUR APPLICATION

Each of the underlined documents below (A-J) should be sent together in your application packet. Those

documents not underlined may be sent separately. Follow each format carefully.

APPLICATION FORM

$50 APPLICATION FEE Make check or money order payable to Rutgers University in the

amount of $50.00. This payment is non-refundable.

QUESTIONNAIRE Type your answers on a separate sheet of paper and list them

consecutively. Use no more than one-half page for each question. Use extra pages as

necessary and write your name on each added page.

THREE (3) LETTERS OF RECOMMENDATION IN SEALED, SIGNED ENVELOPES

You must use the enclosed Recommendation Forms.

A Recommendation Form must be included with each letter of recommendation for the recommendation to

be accepted.

Complete Section I of each Recommendation Form. Be sure to sign the waiver before sending it to the

recommender to complete.

To ensure that the Recommendation Form is filled out correctly and to avoid any delay

of your application, please tear off the sections on the attached sheet (Instructions for

Recommendation Writer) and submit along with the Recommendation Form to the

recommendation writer.

DO NOT OPEN THE ENVELOPE. THIS WILL INVALIDATE THE RECOMMENDATION.

SAT SCORES

Submit SAT scores with your application if you have taken them. The institution code is 2765.

ACT SCORES

Submit ACT scores with your application if you have taken them. The institution code is 2592.

G. TRANSCRIPTS

The Program only accepts OFFICIAL transcripts. Copies and/or unofficial transcripts are

not acceptable. NOTE: If a school refuses to mail your transcript directly to you, do not

call this office. Request that it be mailed to the PA Program (see Section II) and clip a

note to the front of your application listing which transcripts are being mailed

separately.

A transcript from EVERY college, university, and professional school that you

Department of Physician Assistant Studies and Practice

Rutgers, The State University of New Jersey

675 Hoes Lane West, 6

floor

Piscataway, NJ 08854-5635

http://shp.rutgers.edu

p. 732-235-4445

f. 732-235-4820

attended, including the school(s) where courses were taken at the college level while in

high school must be submitted, even if: a. the credits you earned at one school appear on

the transcript of another school. b. you attended a school for only one semester. c. you

withdrew from the school before completing a semester. d. you took only one course,

which you completed, withdrew from, or failed. e. the credits you took were not

relevant to any particular course of study. Note: If you completed a prerequisite course

required for our program under a different title than what is outlined on our website or

received Advanced Placement (AP) credits or have taken a CLEP exam, please forward

a course description or AP/CLEP official documentation along with your application.

Please note that the CLEP code for our institution is 2145. The above transcripts must

remain in the original sealed envelope from the school or institution. DO NOT OPEN

THE ENVELOPE. THIS WILL INVALIDATE YOUR APPLICATION

At the end of each semester after the applicant has submitted their application, the applicant

is responsible for sending updated transcripts when they become available.

H. FOREIGN TRANSCRIPT EVALUATIONS

All foreign transcripts must be evaluated by an evaluation agency and submitted to Rutgers

University PA Program in support of your application. Applicants may use any agency that

is recognized by the National Association of Credential Evaluation Services

(https://www.naces.org/members). World Education Services, Inc. is recommended.

I. DEGREE TRACK SHEET

Signed by the applicant, the Major Department Advisor, the 3+3 advisor (Rutgers: either

Dr. Vogel or Dr. Carr Schmidt), and an advisor from the Dean (Rutgers: SAS Advising

Dean), indicating that the student understands that they must complete all the undergraduate

degree and necessary major requirements by the end of their junior year and that they are

on track, with the transfer credits from the PA program, to complete their undergraduate

degree by May 2025.

J. EMAILING YOUR APPLICATION/DEADLINE FOR APPLYING

All applications and supporting documents must be postmarked no later than June 1

. Mail

all the above underlined documents together to the address listed below.

Rutgers PA Program, 6

Floor

Attention: Admissions

675 Hoes Lane West

Piscataway, NJ 08854

II. IMPORTANT FACTS FOR APPLICANTS

A. Once your application is complete and has been reviewed, one of the following will occur:

l. The PA program will invite you to attend an interview.

Your application will be placed on hold until more applications are reviewed.

The PA program will notify you by email that your application has been declined for admission.

B. Financial Aid. Inquiries about financial aid should be directed to Rutgers University

Financial Aid Office at 732-23S-4689.

C. Questions? If you have any questions, please contact the Physician Assistant Program (732-23S-4445).

REMINDER: Incomplete applications will not be considered for admission. The PA program will not accept missing

documents or payments after the deadline.

A complete packet includes:

a. Completed, signed application form.

b. Check or money order for $50 payable to Rutgers University.

c. Completed questionnaire.

d. All three (3) recommendation forms. Each form must be in a sealed envelope with signature across the

seal.

e. An official transcript from every school you attended after high school.

f. Signed Degree Track Sheet

Your name should appear on every page of your application.

DEGREE TRACK SHEET (page 1 of 2)

Rutgers, The State University of New Jersey Physician Assistant Program

3+3 Undergraduate School: _______________________

Name: _______________________________________Street Address: ______________________________

City: _________________________ State: _______ Zip Code: ____________________

Instructions: Complete this Degree Track Sheet and obtain the appropriate signatures listed below. Include this sheet with

your completed BA/MS or BS/MS (3+3) application and attach your degree audit. Please make a copy for your records.

Deadline to Apply: June 1

(at the end of the applicant’s sophomore year).

To ensure that your application is completed and submitted by the June 1

deadline, please schedule an appointment with

each advisor and the dean to review your courses and obtain their signatures.

Policy: All the undergraduate required courses for the major must be completed by the end of the Spring Semester prior to

the student entering in August (fall semester of senior year).

Fall Semester Courses (Junior Year)

___________________ ___________________ ___________________

Spring Semester Courses (Junior Year)

___________________ ___________________ ___________________

Department of Physician Assistant Studies and Practice

Rutgers, The State University of New Jersey

675 Hoes Lane West, 6

floor

Piscataway, NJ 08854-5635

http://shp.rutgers.edu

p. 732-235-4445

f. 732-235-4820

DEGREE TRACK SHEET (page 2 of 2)

Applicant’s Responsibility: It is the responsibility of the applicant to comply with separate

graduation procedures through their undergraduate Registrar’s Office for the baccalaureate

degree. Students accepted to the PA Program through the articulation agreement will comply

with procedures and deadline dates to graduate upon successful completion of the first year of the

PA Program. Students not accepted into the PA Program will comply with procedures and

deadline dates to graduate upon successful completion of their baccalaureate requirements.

Please fill in the blank lines:

I am an undergraduate student at ________________ enrolled in the PA track.

I have read and understand the above policies:

Applicant Signature: _________________________ Date: __________________

___________________ _____________________ ____________________

3+3 Advisor’s Signature Printed Name Date

___________________ _____________________ ____________________

Major Advisor’s Signature Printed Name Date

(if different than 3+3 Advisor)

___________________ _____________________ ____________________

Advising Dean’s Signature Printed Name Date

http://shp.rutgers.edu

p. 732-235-4445

f. 732-235-4820

Department of Physician Assistant Studies and Practice

Rutgers, The State University of New Jersey

675 Hoes Lane West, 6

floor

Piscataway, NJ 08854-5635

Rutgers, The State University of New Jersey Physician Assistant Program

APPLICATION FORM

Type all information.

Indicate any name(s) you have previously used, such as a maiden name (No. 2).

Directions for No. 20:

• Include only the high school from which you graduated.

• List all schools you attended after high school, even if you did so for less than one semester.

• List the most recent school first.

• Note: Your application will be delayed if you do not enter all schools.

If you list that you have been trained in EMS, you must provide documentation.

Be sure your name is on every page, including any supplements that you attach.

1. __________________________________________________________________________

First Name Last Name Middle Name

2. Any other names used: _______________________________________________________

3. Permanent Legal Address:

Street Address: ______________________ City: ______________________

State:_______________ Zip Code: __________________

4. Preferred Mailing Address (fill out if different than permanent legal address):

Street Address: ______________________ City: ______________________

State:_______________ Zip Code: __________________

5. Telephone number: ________________ Alternative number: _________________

6. Email address (required): _______________________________________________

7. Additional languages spoken:

_______________________ ________________________

Language Proficiency level (beginner, intermediate, advanced, or native)

_______________________ ________________________

Language Proficiency level (beginner, intermediate, advanced, or native)

_______________________ ________________________

Language Proficiency level (beginner, intermediate, advanced, or native)

Department of Physician Assistant Studies and Practice

Rutgers, The State University of New Jersey

675 Hoes Lane West, 6

floor

Piscataway, NJ 08854-5635

http://shp.rutgers.edu

p. 732-235-4445

f. 732-235-4820

8. Circle one:

US Citizen

Refugee

Permanent Resident Alien (provide registration number and expiration date: ______________________)

9. Country of Citizenship (if not US): _________________________________________________

10. Place of Birth including City (if not US): ____________________________________________

Visa Classification (circle one, if applicable)

B2 F1 F2 J1 J2 H1 H4 TN Other: _______________

Expiration date of visa: __________________________

11. Veteran of the Armed Forces (circle one):

Yes No

Military Branch:_______________

Dates of Service:_______________

12. Gender or sex: _____________________________

13. Date of Birth: ______________________________

Rutgers-SHP does not discriminate in admissions or access to its programs and activities on the basis of

race/color, national origin, ethnicity, religion/creed, disability, age, marital status, gender, sexual orientation or

veteran’s status.

Rutgers-SHP is committed to complying with the requirements of the American with Disabilities Act. Rutgers,

the State University of New Jersey is an Affirmative Action/Equal Opportunity Employer.

14. List all educational institutions attended, including the high school from which you graduated. List most

recent first, starting with the institution you are currently attending if applicable, and concluding with high school.

Attach a supplement, if necessary.

Name of

Institution

City of

Institution

Date of

Attendance

Diploma/Degree

Date Received

15. List courses in which you are currently enrolled:

16. SAT Scores, if applicable:

Evidence-Based Reading _____ Evidence-Based Writing and Language ____ Math _____

Date taken:____________

17. ACT Scores, if applicable:

English _____ Mathematics ____ Reading _____ Science_____ Writing _____

Date taken:____________

18. GRE Scores, if applicable:

Verbal score:_______ Verbal Percentile: _______

Quantitative score: _______ Quantitative percentile: _______

Analytical score: ________ Analytical percentile: ________

19. TOEFL Score, if applicable:

Total score:______ Reading score: ______ Listening score: ______

Writing score: ______ Speaking score: ______

Voluntary and Confidential Information: failure to respond to numbers 20, 21, or 22 will not affect the

status of the application.

20. To determine if you come from an economically disadvantaged background, you are asked to compare your

parental family’s size of household (number of exemptions listed on parent’s Federal 1040 income tax forms) and

adjusted gross income against the chart provided in the link below. The chart is based on 200 percent of Federal

Low-Income poverty guidelines. You should use your parent’s most recent tax forms regardless of age.

Please click here for guidelines: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines

Your parent’s family incoming falls within the table’s guidelines and you are considered to have met the criteria

for economically disadvantaged (circle one): Yes or No

21. What is the type of geographic area where you were raised (check one):

__ Urban (1,000,000 population) __Large Town (population 10,000-49,999)

__ Large City (population 100,000-1,000,000) __ Small Town (population 2,500-9,999)

__ Mid-Size City (population 50,000-99,999) __ Isolated Rural (population <2,5000)

Voluntary and Confidential Information: failure to respond to numbers 20, 21, or 22 will not affect the status of

the application.

22. Background Information – check if any of the following apply to you:

____ I graduated from a high school from which a low percentage of seniors received a high school diploma.

_____ I graduated from a high school at which many of the enrolled students are eligible for free or reduced-price

lunches.

_____ I am from a family that receives public assistance (e.g., Aid to Families with Dependent Children, food

stamps, Medicaid, public housing).

_____ I am from a family that lives in an area that is designated as a Health Professional Shortage Area, or a

Medically Underserved Area.

_____ I participated in an academic enrichment program funded in whole or in part by the Health Careers

Opportunity Program

_____ I am a high-school drop-out who received AHS diploma or GED or I am receiving public assistance.

_____ I am from a school district where 50% or less of graduates go to college or where college education is not

encouraged.

_____ I am the first generation in my family to attend college(neither my mother nor my father attended college).

_____ English is not my primary language.

By designating any of the above, you are considered to have met the criteria for educationally/environmentally

disadvantaged as defined by the above guidelines.

Experiences (required section)

List chronologically all health/shadow/community/work/research experience, certifications, and

awards/honors/memberships/leadership under each section accordingly. Include all health-related experience,

paid or voluntary. Indicate total accrued hours. Attach a supplement if necessary.

Patient Care/Other Healthcare Experience:

Employer: __________________________________________________________________________

Supervisor: _________________________________________________________________________

Telephone: _________________________________________________________________________

Frequency: _________________________________________________________________________

Total Hours: ________________________________________________________________________

Dates of Employment/Service: __________________________________________________________

Current job (yes or no)? _______________________________________________________________

Compensated (yes or no)? ______________________________________________________________

Duties: _____________________________________________________________________________

Healthcare Shadowing Experience: