Confidential Applicant Assessment Form and Letter of Reference

Deadline: February 1, 2021 (extended to February 8, 2021)

Each applicant to the BScPA Physician Assistant Professional Degree Program is required to secure one referee to complete the Applicant Assessment Form and provide a Letter of Reference. It is the responsibility of the candidate to secure a referee who meets the requirements listed below. Should a referee not meet these requirements, the reference letter will be deemed unacceptable, and therefore the application will be incomplete and may not be considered.

  • Only one reference (the first received) will be accepted
  • My referee has knowledge of my performance as a health care provider
  • My referee is in a position to make reasonable statements concerning my character, personal qualities,  and clinical abilities/professional attitudes
  • My referee has supervised me in a clinical setting OR My referee has not supervised me in a clinical setting because I have worked independently with no direct supervision. My referee is a professional colleague or someone in a capacity to comment on my professional/clinical skills (e.g. a physician who referred patients to my services)
  • I have not provided health care services to my referee
  • I have not received health care services from my referee
  • My referee is not a member of my family nor a personal friend

Instructions for Applicant

  1. Fill in your information on the Applicant Assessment Form: 
  2. PDF icon Applicant_Assessment_Form_2021.pdf (698.51 KB)
  3. Forward this form to your referee to complete and submit directly on your behalf.
  4. Ensure that your referee is aware that they are also to write a letter of reference for you (see instructions below and on Applicant Assessment Form). Both documents must be received to be considered complete.
  5. Candidates will be able to verify that the BScPA Program received the documents from the referee after approximately one week, via the admissions portal at Referees will not receive a confirmation of receipt from the program.

Instructions for the Referee

  1. Complete and sign the Applicant Assessment Form provided to you by the applicant
  2. Create a letter of reference on letterhead, following the directions on the Applicant Assessment form for content.
  3. Sign the letter of reference.
  4. Send the completed and signed confidential Applicant Assessment Form and letter of reference to the BScPA Program via email.


Only signed submissions directly from the referee will be accepted.