Northern & Rural Cohort Supplemental Application for September 2018 entrance

MPT Admissions - Northern and Rural Cohort Application Form

  • Enter your UBC Student number here (ie: 12345678)
  • Section 1: Lived Experience

    Pease provide a list of locations in Canada in which you resided along with the duration spent in each location. You will need to provide the dates and locations for Birth-Preschool, Elementary School and High School, up to a maximum of 5 locations for each age group. You will also need to provide the list of the locations in which you resided for study and/work since High School Graduation, along with the duration for each. Each entry for Post- Secondary should be a minimum of 3 months and should represent your primary address at the time.
  • Start date (mm/dd/yyyy)End Date (mm/dd/yyyy)Total MonthsLocationProvinceContact TitleContact NameContact Email or phone number 
    Add a new row
  • Start date (mm/dd/yyyy)End Date (mm/dd/yyyy)Total MonthsLocationProvinceContact TitleContact NameContact Email or phone number 
    Add a new row
  • Start date (mm/dd/yyyy)End Date (mm/dd/yyyy)Total MonthsLocationProvinceContact TitleContact NameContact Email or phone number 
    Add a new row
  • Start date (mm/dd/yyyy)End Date (mm/dd/yyyy)Total MonthsLocationProvinceContact TitleContact NameContact Email or phone number 
    Add a new row
  • Section 2A: Decision to Apply to the Northern and Rural Cohort

    Please explain your reasons for choosing to apply to the Northern and Rural Cohort of the MPT program, as well as the experiences that contributed to this decision.
  • Section 2B: Affinity for Rural Training and Practice

    As part of the Northern and Rural Cohort you will complete the majority of your placements in northern and rural communities. Discuss some of the challenges and rewards you think you will experience while on placement in a rural community.
  • Section 2C: Affinity for Rural and Training and Practice

    Briefly describe your experiences (working or volunteering) and activities (academic or extracurricular), not exclusive to rural, that provide evidence of your involvement and leadership in increasing the well-being of individuals, groups or society in general. Please provide verification details in the second box below.
  • Section 3: Previous experiences

    List the names of facilities and locations, approximate duration (number of hours), and the populations with whom you interacted.