MARQUETTE UNIVERSITY
Supplemental Application Form for Admission to the Master of Physician Assistant Studies Program
Instructions: Please download the document and save it before entering your information. Once you
have saved the document and entered your information, save again before uploading to CASPA.
AUTOBIOGRAPHICAL INFORMATION
Name: __________________________________________________________________
_________________________________
Last Jr., etc. First Middle
___________________________________________________________________________
________________________
If any of your records are under a different name(s), please indicate.
Gender:
Male Female
Date of Bi
rth: _________________________________________ Marquette I.D. Number (if applicable): _______________________
Current mailing address: _________________________________________________________________________________________
Number and Street
___________
___________________________________________________________________________________________
City, State ZIP Code
Primar
y Phone Number: _________________________________ Additional Phone Number: _______________________________
Current email address: __________________________________________ (Please circle if the email address is for: home, school, other)
The current address and telephone are effective until: __________________________________ (
Month Day Year)
Are you a repeat applicant? Yes No If yes, which admissions cycle did you apply?_________________________________
ACADEMIC BACKGROUND
Please include all institutions attended:
Name of Institution City, State Dates Attended Degree Awarded (Ex: Bachelor’s-Major,
Masters-Area of Study, Non-degree)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
OPTIONAL QUESTIONS
Special Note: Marquette University admits students based on academic qualifications. Data collected from
optional questions is used for research and provision of special services.
Marital Status Single Married
Citizenship: U.S. citizen Permanent resident Not a U.S. citizen or permanent resident.
Explain:__________________________________________
Ethnicity:
Are you Hispanic/Latino? Yes No
Select one or more: Native Hawaiian or other Pacific Islander White Asian
American Indian or Alaska Native Black or African American
