PAS Residency Program Application | University of Kentucky College of Health Sciences

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Home » Academics » Academic Programs » Physician Assistant Studies » Residency Program

PAS Residency Program Application

Deadline to apply: April 30th

UK students or staff with a LinkBlue ID and password may log into the CHS website to save edits on their application. Unfortunately, if an applicant does not have a UK account they will not be able to save their application progress. We apologize for the inconvenience this may cause.

To log into the CHS website, click the menu icon at the top right, and click "Log In".

Full Name *

Date *

Month

Day

Year

Program Of Application *

Residency: Critical Care

Residency: Acute Care Surgery

Resdiency: Surgery-Baptist-Lexington

Residency: Hospital Medicine

Demographics

Current Address

Street Address *

City *

State

Country *

Zipcode

Permanent Address

Street Address *

City *

State

Country *

Zipcode

Preferred Phone Number *

Preferred Email *

Gender *

Other

Date of Birth *

Month

Day

Year

County of Birth

State/Province of Birth

Country of Birth

Race *

Are you eligible to work in the United States? *

Other Information

Military Status

Military Branch

Still Serving

Languages

Education

Undergraduate Institution *

Dates Attended *

Degree/Major/Minors *

Graduate/Professional Institution *

Dates Attended *

Degree/Major *

Experience

Experience

Clinical Experience

Leadership

Volunteer

Extracurricular

Research

Teaching

Achievements

Honors

Scholarship

Professional Memberships

Publications

Clinical Experience Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Total Hours of Clinical Experience *

Leadership Experience Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Total Hours of Leadership Experience *

Volunteer Experience Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Total Hours of Volunteer Experience *

Extracurricular Experience Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Total Hours of Extracurricular Experience *

Research Experience Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Total Hours of Research Experience *

Teaching Experience Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Total Hours of Teaching Experience *

Achievements Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Honors Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Scholarship Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Professional Membership Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

Publication Information *

Please Include Program/Organization Name, title of experience, dates completed, hours completed, description, Start date, and end date.

License/Certification *

Please include organization name, certification type, date expires, and details of certification.

In what Country did you spend the majority of your Life from Birth to Age Eighteen? *

In what State/Province did you spend the majority of your Life from Birth to Age Eighteen? *

I am from a family that lives in an area that is designated as a Health Professional Shortage Area, or Medically Underserved Area *

I am the first generation in my family to attend college (neither my mother nor my father attended college) *

English is not my primary language *

Uploads

Personal Statement *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

CV/Resume *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Note: Each reference will be contacted by the program to complete a one-page reference rating evaluation form.

Reference from Graduating PA Program Director or Department Chair *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Reference from PA Program Faculty Advisor *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Reference from a Medical Clinician on a Clinical Rotation *

Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf doc docx.

Official Transcript- Undergraduate *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Official Transcript- Graduate *

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Official Transcript- Professional

Files must be less than 2 MB.
Allowed file types: pdf doc docx.

Have you ever plead guilty or no contest to a misdemeanor criminal offense, or been found guilty by a court of such a criminal offense? *

Yes

No

Explanation 1 *

If you answered "Yes" to the previous question, you must provide an explanation. Include 1) a brief description of the incident and/or arrest, 2) specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.

Have you ever plead guilty or no contest to a felony criminal offense, or been found guilty by a court of such a criminal offense? *

Yes

No

Explanation 2 *

If you answered "Yes" to the previous question, you must provide an explanation. Include 1) a brief description of the incident and/or arrest, 2) specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.

Have you ever had any certification, registration, license or clinical privileges revoked, suspended or in any way restricted by an institution, state or locality? *

Yes

No

Explanation 3 *

If you answered "Yes" to the previous question, you must provide an explanation. Include 1) a brief description of the incident and/or arrest, 2) specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.

Have you ever been disciplined by any college, university, or professional school for: (1) unacceptable academic performance (academic probation, suspension, dismissal, etc.) or (2) conduct violations? *

Yes

No

Explanation 4 *

If you answered "Yes" to the previous question, you must provide an explanation. Include 1) a brief description of the incident and/or arrest, 2) specific charge made, 3) related dates, 4) consequence, and 5) a reflection on the incident and how the incident has impacted your life.

Verification *

I certify that all of the information and statements I have provided as part of this application process, including those statements contained in the application and as part of the evaluation verification process are current, accurate, and complete to the best of my knowledge. I understand that withholding information requested as part of the application process, or submitting false or misleading information may be grounds for denial of admission by the program or expulsion from said program after admission.

UNIVERSITY OF KENTUCKY PHYSICIAN ASSISTANT TECHNICAL AND BEHAVIORAL STANDARDS

One of the requirements for completing this application is the acknowledgement that that you have read, understand and can adhere to the Technical and Behavior Standards required for student matriculating into the Physician Assistant Post-Graduate Program. Please review the technical standards, and the behavioral standards.

I hereby acknowledge that I have read, understand and can adhere to the Technical and Behavioral Standards for the College of Health Sciences Physician Assistant Post-Graduate Program. I have been informed that the code of behavior described herein is the official behavior code for all employees, medical staff, faculty, students, and volunteers of University Hospital and the Ambulatory Care Program, and that the standards apply to all individuals who come into contact with patients or participate in activities associated with patient care.

I understand that as a participant in patient care services I shall be expected to maintain and uphold these specific standards and the intent of these standards in the performance of my duties and responsibilities.

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