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Director Davis performing PT on a test patient while two students observe
School of Physical Therapy
DPT Early Assurance Program Application

DPT Early Assurance Program Application

Applicant's Information

Name(Required)
Date of Birth(Required)
Email(Required)
Demographic Data (check all that apply)
The information requested in this section is utilized to meet Federal and State requirements. Your optional but important responses will not be used in the admission process. College and universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic backgrounds of our students and employees.
Home Mailing Address(Required)

Parent/Legal Guardian Information

Name(Required)
Type(Required)

Applicant's High School Information

School Address(Required)
School Counselor's Name(Required)
School Counselor's Email(Required)

Applicant's References

Reference #1 Name(Required)
Reference #1 Email(Required)
Reference #2 Name(Required)
Reference #2 Email(Required)
Family Educational Rights & Privacy Act Waiver:(Required)
Signature indicates student has read and understood the terms and conditions of this waiver agreement.
Full Name of Primary Parent/Legal Guardian(Required)
If the student is under 18 years of age at the time of submitting this DPT Early Assurance Program application, the parent/legal guardian of the student must also sign the document if the student chooses to waive the FERPA protections. I hereby certify by my signature that I am the parent and/or legal guardian of the applicant and that I have read and understood the terms and conditions of this waiver agreement. I also understand that if it is discovered that this is not the true and actual signature of the parent or legal guardian, the application may be declined.
Who or what influenced you most in your decision to apply for admission to Marshall University's DPT Early Assurance Program? (Please check all that apply.)(Required)

Agreement & Signature

By submitting this application, I hereby certify all my answers are true and accurate to the best of my ability. I hereby certify I have read and understand the information as presented in this application and I agree if accepted, to abide by the rules of the DPT Early Assurance Program. I also certify I have read and understand the Special Services, Equal Opportunity Policy Statement, the Annual Security and Fire Safety report, The Consumer Information and Disclosure policy statements included in your undergraduate application information. I understand the DPT Early Assurance Program will be governed by an honor code that requires honesty, integrity, and non-discrimination in my interactions with others, and that a breach of this code could result in expulsion from the program.
Date of Submission