Master in Physician Assistant Studies Application Form

Thank you for your interest in Concord University's PA Program. This application is for current Concord students and Concord alumni only. The following information is the first part of your free application. The second portion of your application will be in your applicant portal, where you will receive the login information to the email you provide below.

Please note: if you exit this page, all progress will be lost, and you will be redirected to start again.

Which pathway are you applying to? (Note: Fast Track is for current, full-time, undergraduate CU students)

Which term are you applying for?

Fall 2025

Fall 2026

Profile

First Name

Last Name

Middle Name

Preferred First Name

Other Last Names Used (if applicable)

Birthdate

Sex

Female

Male

Contact Information

Preferred Phone Number (no dashes)

May we text this number?

Yes

No

By providing my consent, I agree to receive text communications from Concord University. Reply STOP at any time to unsubscribe. Message & Data rates may apply.

Alternate Phone Number (no dashes)

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Physical Address

Country

Street

City

Region

Postal Code

Reference Contact Information

Please let your reference know they will be receiving an email from pa@concord.edu.

Contact 1 Full Name

Contact 1 Email Address

Contact 2 Full Name

Contact 2 Email Address

Contact 3 Full Name

Contact 3 Email Address

Citizenship and Residency Information

Primary Citizenship

Dual Citizenship

Permanent Resident

Are you a resident of the state of West Virginia?

Yes

No

How long?

Less than 1 year

1 year

2 years

3+ years

Many groups, primarily federal government-related and accrediting associations ask colleges and universities to describe the ethnic/racial backgrounds of their students and employees. To respond to these requests, we ask you to answer the following two questions:

*These answers will not be visible to the admissions committee members who review your application for interview.

Do you consider yourself Hispanic or Latino?

Many groups, primarily federal government-related and accrediting associations ask colleges and universities to describe the ethnic/racial backgrounds of their students and employees. To respond to these requests, we ask you to answer the following two questions:

*These answers will not be visible to the admissions committee members who review your application for interview.

Do you consider yourself Hispanic or Latino?

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Academic History

Did you attend any other universities before Concord University or were enrolled in another post graduation? (This does not include dual enrollment)

Yes

No

Please list the university(ies) and date range below:

Note: An official transcript MUST be received to the University directly from the registrar of other college or transcript service (except Concord)

Do you have any self-identified deficiencies (withdrawals, repeated prerequisite, etc.) in your academic performance you wish to explain to the admissions committee?

Yes

No

If yes, please use the space below.

Have you ever previously been enrolled as a student in a Physician Assistant program, Medical School (including foreign), or any health profession, including but not limited to DO, Dentistry, Physical Therapy, Occupational Therapy, Chiropractic, Podiatry, etc.?

Yes

No

Other

“The Concord University Physician Assistant Program is active in the development of a PA program in preparation for entry into accreditation by the ARC-PA via the provisional accreditation pathway. The ARC-PA has determined that our institution has met the basic eligibility requirements to apply for accreditation, as noted in the accreditation Standards. We do not yet possess an accreditation status from the ARC-PA, nor are we guaranteed to achieve provisional accreditation.”

I understand I am applying to a developing program, defined above, which may or may not receive provisional accreditation.

“The Concord University Physician Assistant Program is active in the development of a PA program in preparation for entry into accreditation by the ARC-PA via the provisional accreditation pathway. The ARC-PA has determined that our institution has met the basic eligibility requirements to apply for accreditation, as noted in the accreditation Standards. We do not yet possess an accreditation status from the ARC-PA, nor are we guaranteed to achieve provisional accreditation.”

I understand I am applying to a developing program, defined above, which may or may not receive provisional accreditation.

Yes

No

Are you active military, a veteran or a dependent of a veteran?

Yes

No

If yes, please select below:

Active Military

Dependent

National Guard

Veteran

I understand that if I have a criminal history or am designated as a sex offender, I may be prohibited from enrolling in a PA program and/or may not be able to secure clinical placements, even if I am extended an offer of admission. I further understand that I may be required to provide criminal background history information and/or submit to a criminal history check (a) as a condition of participation in clinical practices experiences required for graduation, and (b) as a condition of licensure as a PA under applicable state law. All decisions regarding actions in relation to an applicant's criminal history are within the discretion of each PA program in accordance with applicable state law. In addition, if I have been found guilty of committing acts that are contrary to public health and safety, even if I enroll in and successfully graduate, I may be unable to obtain a license to practice as a PA under applicable state law.

Yes

I certify that the information on this application is complete and correct, and I understand that the submission of false information is grounds for denial of my application, withdrawal of any offer of acceptance, cancellation of enrollment, or any appropriate disciplinary action. I understand this includes the use of ChatGPT or other generative AI for my application. I authorize Concord University to verify the information I have provided with all the schools I have attended. I agree to notify Concord University Physician Assistant Program immediately of any changes in the information provided.

Signature