MCHS Supplemental Application Form

Overview

All applicants to MEDEX Northwest are required to complete the MEDEX Supplemental Application on or before the final application deadline of September 1st to be considered for the current admissions cycle. Applicants must also complete the CASPA Application prior to the September 1st application deadline; applicants may submit their MEDEX Supplemental Application as soon as their 10-digit CASPA Identification (ID) number has been assigned. MEDEX will begin the initial screening and file review process only after both the CASPA Application and the MEDEX Supplemental Application have been received.

Instructions

Review the prerequisites for the master's degree option as well as the Technical Standards document prior to filling out the supplemental application. In order to apply to the MEDEX Northwest Physician Assistant Training Program, you will need to check off that you meet all the prerequisites on this list. No one will be exempt from meeting these minimum standards, regardless of prior training, education, or medical experience.

Fill in all applicable information completely and accurately. Do not hit the back arrow or navigate away from the supplemental application, as this could reset the form. It is recommended that you complete the essay portion in an external editor (Microsoft Word, for example) and then copy the essays into the application. Be sure to format personal statements using spaces between paragraphs.

Ensure that you have entered your 10-digit CASPA ID number correctly in the space provided; if you submit the supplemental application with an incorrect CASPA ID, the application will not go through the initial screening and file review process. Before submitting the supplemental application:

  • Confirm that you have the correct CASPA ID number
  • Double-check your submission for accuracy and content
  • Print a copy of the supplemental application for your records
  • You will not be able to revisit your application once it is submitted

Personal Information

Your 10-digit CASPA Applicant ID Number (e.g.: 1234567890)*


Your supplemental application cannot be processed without your CASPA Applicant ID #. If you submit this application using an incorrect CASPA Applicant ID #, we will not be able to match this application to the CASPA application and you will not be considered for admission.

Entering MEDEX:

2019

Current Legal Name (First/Last):*

Previous Legal First Names:

Previous Legal Last Names:

Current Name (if different from legal name):

Personal Pronouns (optional):

Email address:*

Please note: E-mail is our primary way of contacting each applicant.

Phone Number:*

Example: 2065555555

Languages spoken:*

Indicate whether you have applied to the MEDEX program within the last five (5) years.

Are you a re-applicant?*

If yes, did you interview?

If Interviewed, in what year(s)?

Military experience:

Indicate whether you have military experience.*

Campus Location Selection


MEDEX Northwest offers its curriculum at four campus locations. The Seattle and Tacoma campuses are located at the University of Washington in their respective cities. The Spokane campus is located at Gonzaga University and the Anchorage campus is located at the University of Alaska, Anchorage. The Master of Clinical Health Services (MCHS) degree is offered at all four locations.

Select your first and second campus location preferences using the drop-down box below:


First Choice for Campus Location:*

Second Choice for Campus Location:*

In selecting your campus location options, consider what campus location would best contribute to your success during PA school. MEDEX aims to place applicants at their first campus location preference, however, due to the size and competitiveness of the application pool and the seats available at each campus, some applicants will be offered interviews at their second campus location preference.

If you have restrictions on where you are able to or want to attend PA school, please select “None” as your second campus preference and you will only be considered for your first campus preference.

As you may be offered an interview at either campus location you select above, you will be notified of the campus you are being considered for at the time you are invited to interview. Candidates who are placed on the hold list after interview may still be considered for seats at their second campus location preference.

If you are interested in attending the MEDEX Northwest Hawaii campus, please indicated “Kona, HI” as your first location and choose your second campus location preference. While expansion to Hawaii is subject to approval by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), all Hawaii applicants will be required to select a second campus location (Seattle, or Tacoma, WA). If the Hawaii expansion is not available for the 2020 entering cohort, those students will be admitted to their second campus preference. All Hawaii applicants must be willing to attend their second campus location if they are selected and the Kona location is not available.

MEDEX aims to place students at the location that best contributes to their success for the duration of their PA education. Please indicate below your connections to the campus locations you have selected. Check all that apply. (WWAMI refers to Washington, Wyoming, Alaska, Montana, and Idaho). Applicants are encouraged to list their connections to Hawaii in the “Other” category below, if applying to that campus.

Other: (text limit 200 characters)

MEDEX Prerequisites

Check off the following prerequisites that apply to your application to the master's degree option. All prerequisites must be completed with a minimum B- (2.7) or better.

Instructions for coursework grade entry:

Grades must be entered below in either letter grade format (A-F) or GPA format (4.0 scale) to reflect the grade that appears on an applicant’s transcript. Any individual course with a grade below a B- or 2.7 will not be accepted as a qualifying MEDEX prerequisite. Grades entered for courses with stand-alone labs should reflect the lecture portion only. Do not enter grades for stand-alone lab coursework.

For in-progress coursework, enter “IP” as the Final Grade. In-progress courses must be completed prior to the September 1st deadline, with an official transcript sent directly to MEDEX admissions for final grade verification, to be considered in the current application cycle.

For AP English coursework that appears on a college transcript, enter “AP” as the Final Grade. AP coursework is acceptable for English courses only.

For courses completed as part of military training, enter “ML” as the Final Grade.



Completion of college-level coursework in both human anatomy and physiology which, when combined, totals at least ten quarter credits (or six semester hours).


Course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Completion of required college-level science course prerequisites.


General Biology course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Chemistry course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Microbiology course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Completion of one college-level Statistics course.


Statistics course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Completion of two college-level English courses (one must be composition).


English Composition course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

English course name and number:*

Date completed:*

Final Grade (B-/2.7 or higher):*

Other Prerequisites

Confirm that you have read and understand the MEDEX policy compliance relating to the following:

*

*

*

Compliance with the above MEDEX policies is required prior to matriculation. Matriculation is dependent upon these mandatory standards and failure to comply may impact the standing of any accepted student. If you have questions about these policies, please contact us at medex@uw.edu.

Personal Statement*

Please compose a personal narrative statement that answers the above questions. Personal statements allow MEDEX to get a greater understanding of your experience and personal character. Keep in mind that we will have your CASPA personal statement and we do not want a duplication of the CASPA statement. Please limit this personal statement to 1000 words. Remember to format the statements with a space between paragraphs.

1. Tell us how your values and experience make you a good fit for MEDEX. Why is now the right time to apply to MEDEX?
2. What are the biggest challenges you face in returning to school and what is your approach to managing these challenges?
3. What strengths, skills, and perspectives do you bring to the classroom and to healthcare?
4. Do you believe your academic history accurately reflects your academic ability to successfully complete PA school? Please explain.

Reapplicant Personal Statement

Please compose a personal narrative statement that answers the below question. This question is to be answered only by reapplicants to the MEDEX program in addition to the General Personal Statement and it is a requirement for all reapplicants. You are a reapplicant if you have applied to the MEDEX program within the last five (5) years. Please limit this personal statement to no more than 500 words.

Tell us what you have done to strengthen your application to MEDEX Northwest?

Military Training

Please fill in this section only if you have prior military experience.

REMEMBER: submit all documentation to MEDEX Northwest directly. The DD214 and Military Transcripts will be evaluated along with this and the CASPA application. If you have more training experience that you feel is relevant to your application and would like to include it in your application, please send the information with the above documents.

Military Branch served in:

Discharged from military?

Honorable Discharge?

Number of years in Active Military:

Number of years in Military Reserve or Guard:

Highest Rank attained:

Are you currently in the Reserves or Guard?

Are you Active Duty?

Did you mail or email (medex@uw.edu) us a copy of your DD214?

Did you request JST or other military transcripts to be released to MEDEX?

If your discharge was Dishonorable, please explain:

Military Training #1

Please fill in this section only if you have prior military experience.

Type of Training:

Where:

Length:

Certificate or Degree Granted, and date completed:

Military Training #2

Please fill in this section only if you have prior military experience.

Type of Training:

Where:

Length:

Certificate or Degree Granted, and date completed:

Military Training #3

Please fill in this section only if you have prior military experience.

Type of Training:

Where:

Length:

Certificate or Degree Granted, and date completed:

Military Training #4

Please fill in this section only if you have prior military experience.

Type of Training:

Where:

Length:

Certificate or Degree Granted, and date completed:

Military Personal Statement

Please fill in this section only if you have prior military experience.

Please compose a personal narrative statement that answers the below question. This question is to be answered ONLY by Military applicants to the MEDEX program in addition to the General Personal Statement and re-applicant statement (if applicable). It is a requirement for all military applicants. Please limit this personal statement to no more than 500 words.

Which aspect of your professional or clinical Military experience prepared you to enter the MEDEX program and become a Physician Assistant?

International Medical Graduate

If you graduated from medical school in any country other than the United States you are considered an International Medical Graduate. All International Medical Graduates are required to complete the IMG section of the supplemental application.

All International Medical Graduates are required to submit official copies of the translated transcripts directly to MEDEX Northwest or CASPA on or before the application deadline of September 1st. These transcripts are required. MEDEX cannot verify your academic information without the required translated, course – by – course transcript evaluation.

If you have attended any portion of medical school, in the United States or any other country, you also are required to complete this section of the supplemental application.

Have you ever attended medical school for any amount of time in the United States or another country?

If yes, which country?

Did you work as a paid physician in your home country?

What is your Visa type and status?

Have you worked in the US health care system?

If yes, what is your title

How long have you worked in this position?

Did you complete all or part of the USMLE or ECFMG (not required by MEDEX)?

MEDEX Northwest does NOT require the completion of the USMLE or ECFMG and passing these medical licensing exams does not replace the need for completed academic and clinical experience prerequisites to MEDEX Northwest.

Did you complete some clinical residency program in the United States?

All US medical school and doctoral level training program course information must be entered in the CASPA application and all original transcripts must be submitted to CASPA for verification.

If yes, where did you complete a residency program?

TOEFL scores are required for all applicants without a degree in the U.S., Australia, the Bahamas, Canada, Ireland, Jamaica, Kenya, New Zealand, Singapore, Trinidad and Tobago, or the United Kingdom. Scores must be sent to CASPA using the ETS Code #3709 as part of your application. The minimum score accepted on the TOEFL iBT test is a 92.

Have you completed the TOEFL exam? (required by September 1, 2019)

If yes, when was the exam completed?

International Medical Graduate Personal Statement

Please compose a personal narrative statement that addresses the below statement. This question is to be answered ONLY by International Medical Graduate & Prior Doctorate Level Professional Training applicants to the MEDEX program in addition to the General Personal Statement and re-applicant statement (if applicable). It is a requirement for all International Medical Graduate & Prior Doctorate Level Professional Training applicants. Please limit this personal statement to no more than 500 words.

Use an example from your experience with advanced practice providers (physician assistants, nurse practitioners, etc.) to describe how you plan to make the transition from being a physician or independent provider to being a physician assistant. What experience helped you decide to pursue the PA pathway?

Submit*

If you want a copy of this application for your records please print before selecting the submit button.


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