Please make sure you include your name and CASPA ID on your check/money order. If you are sending materials by postal mail, please use the following address in its entirety so that it will reach our office in a timely manner:
Student Affairs and Admissions Office Mercer University COPHS 3001 Mercer University Dr, STE PAC-121 Atlanta, GA 30341
Personal Data
CASPA ID
Please consider this application for the class entering in: January 2013
Gender: Male Female
Full Name
Name you prefer to be called (nickname, if applicable)
Preferred Phone Number (home, work, school and/or cell)
E-Mail address
Religious Preference (optional)
Have you applied to Mercer's PA Program (or any other Mercer program) before? Yes No
If so, when?
If you are reapplying to Mercer's PA Program, please describe how you have improved your application.
How did you first hear of Mercer's PA Program?
Who is (was) your pre-professional or academic advisor?
Name
Title/Department
College/University
City, State and Zip Code
Please list other PA programs which you are considering for attendance:
Do you have relatives who are Mercer University graduates? If yes, please list them (include name, relationship, degree, major and class year).
Have you ever been convicted of any violation of law (include all criminal offenses, i.e., felonies and misdemeanors, infractions, traffic offenses, and everything else except for parking violations, regardless of the final disposition.)? Yes No If the answer is YES, please provide a full explanation including the final disposition of the case in the box below.
Narrative
As part of your CASPA application, you are asked to provide a narrative regarding your motivation towards becoming a Physician Assistant.
At this time, please respond to the question below. Please do not reuse your CASPA statement. (Please limit your narrative to 500 words. This field cannot be left blank.)
How will your hands-on patient care experiences influence your ability to succeed in Mercer’s PA Program and your career as a Physician Assistant? What have you learned about yourself and your ability to work on a team through your experiences?
Optional: Please provide any additional comments or information you would like the Admissions Committee to consider during the review of your application (e.g., causes of any academic difficulty or additional qualifications not already noted). (Please limit this information to 250 words.)
I certify that the information presented in this supplemental application is my own work, factually correct and honestly provided.
By typing your name in this box, we will accept that you acknowledge the above statement.
Mercer University is committed to providing equal educational programs or activities, and equal employment opportunities to all qualified students, employees, and applicants without discrimination on the basis of race, color, national or ethnic origin, disability, veteran status, sex, sexual orientation, age, or religion, as a matter of University policy and as required by applicable state and federal laws, including Title IX. Inquiries concerning this policy may be directed to the Equal Opportunity/Affirmative Action Officer/Title IX Coordinator, Human Resources Office, 1400 Coleman Avenue, Macon, Georgia 31207, phone 478-301-2788 or contact baca_dh@mercer.edu, or in cases of Title IX concerns, these concerns may be referred to the Office of Civil Rights.