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Application Post-Professional Certificate in Pediatrics
or Post-Professional Masters Degree

We welcome your application as a part-time student to Misericordia University. Misericordia is dedicated to enhancing the professional success as well as the personal growth of each of its students. We trust that you will experience both a stimulating learning environment and a supportive "small campus" atmosphere while you are with us.

Application Requirements:

  1. Bachelor's degree or higher in occupational therapy. Send copy of diploma or transcripts to Ms. Larree Brown, Coordinator of PT Studies, Division of Adult Education, 301 Lake St., Dallas, PA 18612
  2. Photocopy of professional state license and registration/certification in occupational therapy. If you have any questions, please contact the Division of Adult Education and Community Service at 570-674-6451 or 866-262-6363.

Choose which program you wish to apply for:

Post-Professional Certificate in Pediatrics Post-Professional Masters Degree


Personal Information:

Name:
Address:
City:
State:
Zip Code:
Telephone: Day Evening
E-mail Address:
Employer:
Employer Address:

Year and semester for which you are applying:
Fall Spring Summer
If you have previously taken courses at Misericordia University, please indicate when:
Are you an Alumna/us of Misericordia University? Yes
No
Are you a dependent or spouse of a Misericordia University employee? Yes
No

Employee's Name:
How did you initially hear about the certificate program?
Word of mouth Alumni Television
Radio Letter Newspaper
College Representative Professional Journal Other:

Is there anything specific that influenced your decision to apply?


Education Information:
College(s)
Training Programs

1.  School Name:
Dates Attended:
Degree:
Address:
2.  School Name:
Dates Attended:
Degree:
Address:
3.  School Name:
Dates Attended:
Degree:
Address:

Acceptance into the program is contingent upon proof of current state licensure.