Online Application for Admissions - PTA Completing the application neither guarantees admission to the degree program, nor obligates you to the college. Please complete all sections of the Application. Your responses will be kept private and secure.(Personal information should match government issued ID) There is a non-refundable processing fee of $100. You must sign your form, so that it will be complete, Thank you! Personal Information Program Of Interest Physical Therapist Assistant (PTA) Social Security Number * Last 4 Digits Only. Date of Birth * Legal Last Name * First * MI Home Address * City * State * Zip Code * Primary Phone * Secondary Phone Do you have a different Mailing Address? * Yes No Mailing Address City State Zip Code Email Address * Enter Email Sex Assigned at Birth * Male Female Self Identify Decline to State Sex Assigned at Birth Please fill in your Self Identifcation Are you 18 years of age or older? * Yes No If under 18 please provide information on Parent or Guardian Parent/Guardian Last Name * First * MI * Parent/Guardian Address City State Zip Code Parent/Guardian Phone Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? * Yes No Have you ever been convicted of any drug related offense? * Yes No please explain below: Citizenship Citizenship Buttons US Citizen US Dual Citizen; please specify other country of citizenshipUS Dual Citizen; please specify other country of citizenship US National US Permanent Resident US Refugee or Asylee Radio Button Other Citizenship (Non-US) Other Citizenship (Non-US) What country are you a citizen of? Demographics The questions in this section, while helpful to us, are entirely optional, and you are welcome to move on without answering them. Are you Hispanic or Latino? Yes No Regardless of your answer to the prior question, please indicate how you identify yourself. (Select one or more) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Previous Education High School: * State: * Graduated? * Yes No Mo/Yr: * format: 11/2014 College/s Attended: State: Graduated? Yes No Mo/Yr: format: 11/2014 College/s Attended: State: Graduated? Yes No Mo/Yr: format: 11/2014 Are you currently taking any college coursework at a college? Yes No Course Name/s: Financial Aid Will you be a candidate for financial aid? Yes No Have you received financial aid from an institution before? Yes No School Name City State School Name City State I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or falsifying of facts on my part make me ineligible for enrollment into Casa Loma College. I also understand that if upon my enrollment, false information was deemed to have been provided; I will be terminated from the college. Next If you are human, leave this field blank.