Cisco College Medical Assistant Program Application

Transcription

1 Cisco College Medical Assistant Program Application Program Director: Angelia Torrez Thank you for your interest in Cisco College s Medical Assistant Program. The MDCA Program has four degree plans to choose from. We are accepting applications. The Medical Assistant Program is a strenuous program requiring your full time commitment and attention. All clinical rotations are during the day from 8am-5pm. Selection criteria are as follows: a. GPA no less than 2.0 b. Biographical essay discussing why you want to become a Medical Assistant. c. Any additional academic, occupational/allied health, or science related courses taken and passed with a C or better are viewed favorably. You are required to provide the Department Head of Allied Health with a copy of your immunization record containing proof (titer, immunization, or physician s documentation of illness) of the following immunizations: Varicella Tetanus-Diptheria MMR-x2 Bacterial Meningitis 2 of 3 Hepatitis B Tuberculin skin test (If under 22 yrs. old) (3 rd before end of program) (Within the last year) Background/Drug Urinalysis Before attending clinicals, a background check and a drug urinalysis are required. Certain convictions may result in denial by a clinical site and/or restrict employment in the healthcare field. These will have to be completed right before clinical rotations; if done too early you may be asked to do it again. The background check is done through GroupOne ( A 10 panel urine drug screen is also required; please use Any Lab Test Now and let them know that you are a Cisco College Student. For more information regarding the program costs, please contact Cisco College Financial Aid Department at or Should you have any questions, please do not hesitate to contact me. Thank you, Angelia Torrez, BSN, RN, CPhT, CMA Program Director: Medical Assisting Cisco College, Abilene Education Center (325)

2 APPLICATION FOR ADMISSION MEDICAL ASSISTING PROGRAM Cisco College does not discriminate on the basis of race, color, creed, national origin, religion, age, gender, sexual orientation, political affiliation or physical disability. APPLICATIONS TO HEALTH SCIENCES PROGRAMS ARE NOT CONSIDERED COMPLETE WITHOUT A COMPLETED IMMUNIZATION FORM. A COPY OF THIS FORM IS INCLUDED IN YOUR PROGRAM HBOOK OR FROM THE ALLIED HEALTH DIRECTOR S OFFICE. PLEASE PRINT OR TYPE APPLICATION DATE Name in Full: Last First Middle Home Address: Number and Street County City State Zip Home Phone: Alternate Phone: Social Security No.: - - Date of Birth: Or Student ID: Have you ever before made an application to any Cisco College Health Sciences program? YES NO If yes, what program? When: (approximate date) It is the student s responsibility to: Return this application to Angelia Torrez, Program Director Medical Assisting, at the Abilene Education Center of Cisco College. It may be returned by mail or in person. PLEASE DO NOT FOLD! The mailing address for Angelia Torrez is 717 E. Industrial Blvd., Abilene, Texas If you need further assistance, please call (325) or visit our website at Please note: Students must keep mailing address current with the Health Science s department as well as the Admissions and Records office, even after graduation date.

3 Give information concerning high school(s) attended or GED: Name of School City and State Date of Completion Give information concerning college, university, vocational schools, allied health schools attended: Name of Institution City and State Number of Credits or Degree Earned IF TESTING WAS DONE AT ANOTHER SCHOOL, PLEASE SUBMIT A COPY OF THE DOCUMENTATION WITH YOUR APPLICATION. List any licenses or certificates held (i.e. LVN, EMT, etc.) Check the box for the Degree Plan that you will be following: Level I Certificate Administrative Level I Certificate Clinical Level II Certificate (take certification exam) Associate Degree (take certification exam) NOTE: ON THE FOLLOWING PAGES YOU WILL FIND TWO CHECKLISTS. THESE ARE FOR YOUR USE TO ENSURE YOU HAVE COMPLETED ALL THE REQUIREMENTS TO BE CONSIDERED FOR THE MEDICAL ASSISTING PROGRAM AT CISCO COLLEGE. THE FIRST CHECKLIST WILL NEED TO BE COMPLETED AS MUCH AS POSSIBLE, SIGNED, SUBMITTED WITH YOUR APPLICATION. THE LAST PAGE IS A SECOND CHECKLIST FOR YOU TO REMOVE KEEP AS A REMINDER FOR ANY REMAINING IMMUNIZATIONS THE DOCUMENTS THAT WILL BE SUBMITTED NEAR THE END OF THE PROGRAM. INCOMPLETE APPLICATIONS, AS REFLECTED BY MISSING ITEMS FROM THE CHECKLIST, WILL NOT BE ALLOWED TO PARTICIPATE IN THE REQUIRED CLINICAL ROTATION.

4 COMPLETION CHECKLIST: Background Check (to be done 2 weeks prior to starting clinical rotation) Drug Screen (to be done 2 weeks prior to starting clinical rotation) CPR card (must be Health-care Provider Level)- Healthcare Education Resources & Supply Co. 625 N. Willis Abilene, TX Contact: Melissa & Sean (325) or mjwoodard60@gmail.com / Biographical essay All applicants must provide a copy of written documentation from a physician for: Proof of Varicella (Chicken Pox) immunity as shown by (a) physician documented history of disease, (b) documentation of two immunizations OR (c) a serum titer confirming immunity. Proof of (a) completion of the first two of the Hepatitis B Vaccination series (the third vaccination in the series must be completed by the end of the provisional semester) OR (b) a serum titer confirming immunity. Proof of (a) two Measles Vaccinations (may be part of a MMR) OR (b) a serum titer confirming immunity OR (c) proof the student was born prior to January 1, 1957 OR immunity as shown by (d) physician documented history of disease. Proof of (a) one Mumps Vaccination (may be part of a MMR) OR (b) a serum titer confirming immunity OR (c) proof the student was born prior to January 1, 1957, OR immunity as shown by (d) physician documented history of disease. Proof of Bacterial Meningitis Vaccination is needed only if you are under the age of 22. Proof of (a) one Rubella Vaccination (may be part of a MMR) OR (b) a serum titer confirming immunity OR immunity as shown by (c) physician documented history of disease, regardless of date of birth. Proof of Tetanus-Diphtheria vaccination within the last 10 years. Proof of a negative Tuberculin skin test within the last year. This application may not reflect recent program changes. Please access the most up-to-date information on the program s website at I hereby certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any misrepresentation or falsification of information is cause for denial of admission or expulsion from the college. I understand that the information contained in this application will be read by the admissions committee of the CC Medical Assistant program. Signature of Applicant Date

5 Please remove and keep for your use Medical Assisting program requirements checklist All documents submitted to Bonny Dove Office #242 Overall GPA of 2.0 or higher Complete Medical Assisting program application Biographical essay discussing why you want to become a medical assistant Proof (titer, immunization, or physician s documentation of illness) for: Varicella Bacterial Meningitis (if under 22 years old) MMR x2 Tetanus-Diptheria (within the last 10 years) 2 of 3 Hepatitis B (3 rd to be completed before you finish the Program) Negative Tuberculin skin test (within 1 year) Copy of Healthcare Provider-level CPR card Drug urinalysis through Any Lab Test Now; you must let them know you are a Cisco student--will be completed 2 weeks prior to beginning your clinical rotation in the last semester* Background check through GroupOne ( be completed 2 weeks prior to beginning your clinical rotation in the last semester* *If the background check and/or drug urinalysis are completed too early, you may be required to resubmit them. ALL DOCUMENTATION MUST BE COMPLETE OTHERWISE YOU WILL NOT BE ALLOWED TO PARTICIPATE IN YOUR CLINICAL ROTATION

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