Army National Guard
Interservice Physician Assistant Program (IPAP) Academic Worksheet
______
Last Name, First Name, Middle InitialSSN MOS / AOC
State POC e-mail address:
Other names listed on transcripts:______Date completed:______
Part I. List all colleges and universities attended and the dates of attendance(semester and year, e.g. Fall 1996) Must have an official transcript from each institution forwarded to NGB prior to application deadline.
College / University and Location Dates of Attendance Total # of Credits Degree
Part II. List all course work currently in progress.
College / University and Location Course in Progress Anticipated date of completion
Part III. List all courses attempted, including those failed, under the appropriate heading. List the semester hours (Sem Hrs) of each course. Quarter (QTR) hours should be converted to semester hours according to the following scale:
QTR Hours SEM HoursQTR Hours SEM Hours
1 .764.0
21.374.7
32.085.3
42.796.0
53.3
Technical courses such as typing, welding and courses taken for certification (Emergency Medical Technician or Licensed Practical Nursing) are not accepted. Do not list these courses.
List additional courses on a continuation sheet if the sections do not provide sufficient space.
English and Literature
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Biological Sciences
(Anatomy & Physiology, Biology, Microbiology, Genetics, Immunology, etc.)
Course Title Sem Hrs / Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Chemistry
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Other Science Courses
(Physics, Botany, Nutrition, Geology, Geography, Astronomy, etc)
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Mathematics
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Psychology
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Humanities and Social Sciences
(Government, Art, Education, Philosophy, History, Languages, Anthropology, Civilization, Music, Speech, Ethics, )
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Other Courses
(Business, Economics, Law, Computer Sciences, CLEP, DANTES, etc.)
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
SUBJECT GPA: ______
Graduate Courses
Course Title Sem Hrs Grade College Date Completed
(Semester & Yr)
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