MA Pathway Program Application

Last 4 digits of your Social Security Number

This is needed to create and/or verify your university ID number

Do you have a High School Diploma/GED?

Applicants must have either a high school diploma or GED prior to the start of the program.

Will you be able to pass a national background check?

We require a national background check upon acceptance to the program.

Will you be able to pass a urine drug screen?

We require a drug screen upon acceptance to the program.

Do you acknowledge that the following immunizations are required and you must submit supporting documentation prior to clinical training?

TB Screening
MMR
Varicella (Chickenpox)
Hepatitis B
Tetanus-Diphtheria-Pertussis (Tdap) Immunization within the past ten years
Influenza

College Education, Degrees, or Certificates Obtained

Please list colleges attended, degrees, certificates (if any), and dates. This experience is not required, but it tells us more about you.

Have you ever attended or been an employee of the University of Utah?

If so, please elaborate.

Personal Statement

Please tell us about yourself.

Will you be able to meet the requirements to complete the online and in-person classes as well as the clinical training?

Anticipated start

If accepted, how soon will you be able to pay tuition and start the program?

Are you a first-generation college student?

Yes = Neither your parent(s) or legal guardian(s) have attained a bachelor's degree.

No = My parent(s) or legal guardian(s) have attained a bachelor's degree.

Yes

Race

Please indicate your race, you may select all that apply.

Signature

I certify that the information on this application is true and complete. Further, I understand that consideration for this program may be denied if any information is found to be incomplete or inaccurate.

Type Name