Allied Health Admissions, CA TEB 103 Fax: N. Killingsworth St. Phone: Portland, OR NOTE: Cell Phone: Other Phone:

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1 Medical Assisting Program Application Received (office use only): Return completed application and all documentation to: Portland Community College Allied Health Admissions, CA TEB 103 Fax: N. Killingsworth St. Phone: Portland, OR NOTE: Students are encouraged to attend an information session or meet with the admissions advisor before applying. Admission is competitive. Generally 24 s are chosen for the Medical Assisting program at the Cascade Campus that starts each fall and 24 s are chosen for the Medical Assisting program at the Willow Creek Center that starts each spring. More s apply than we are able to place in the program. Students are encouraged to get health related experience and to get the best grades possible on all prerequisite coursework see Advising Guide It is your responsibility to ensure all contact information is current and correct, if you change addresses or phone numbers please contact admissions with the correct information. Applicant Information Please Type or Print Clearly PCC ID # G Name: Last First MI Maiden Home Address: City State Zip Cell Phone: Other Phone: PCC Have you applied to the MA program before: No Yes If yes, when? Previous colleges attended: College College For data collection only: In the future we are considering adding a cohort on evenings and weekends. If we had that now would you be interested? Yes No If yes, which campus: WCC Cascade Optional - In case of emergency, please notify: Name: Relationship Address: Cell Phone: Other Phone: STUDENT SIGNATURE DATE Medical Assisting Program Application Page 1 of 7

2 Important Information for Applying Prerequisite Requirements Must pass with a C or better These classes must be completed or concurrently enrolled in during the term applications are being accepted. WR 121 English Composition MTH 58 Math Literacy I or MTH 60 Introduction to Algebra 1 st term (or a higher level math) MP 111 Medical Terminology BI 120 Survey of Body Systems (or BI 121 or BI 231 and 232.) CAS 133 Basic Computer Skills and/or CAS 121 Computerized Keyboarding are highly recommended many employers require applicants to type 45 WPM. NOTE: In the event you wish to substitute a course taken at another college or university for a PCC program requirement please contact the admissions coordinator to ensure that this course is an acceptable substitute. In some cases you may need to provide a course description or syllabus for the course. Requirements for Application Complete all prerequisite requirements by the end of the term the application is due; for example spring term s will need to apply and have all prerequisites completed by the end of fall term. Your Application will not be considered complete until all documents have been turned in Complete the Statements of Understanding on page 3 Complete the Supplemental Essays on page 4 Complete the Supplemental Questions on pages 4 and 5. Submit two Recommendation Forms filled out by counselors, teachers or employers and placed in a sealed envelope signed across the seal on pages 6 and 7. If more than two are received, only the first two we receive will be scored. Provide unofficial transcripts from all colleges that you have attended other than Portland Community College. If you are currently enrolled in any prerequisite coursework at another college you must provide proof of enrollment with your application. Application Timeline All application materials listed above will be accepted Fall Term for Spring admission at the Willow Creek Center, and Spring Term for Fall admission to the Cascade Campus programs. See for specific application dates. The application due date is firm, and all required documents must be in the Allied Health Admission office by that date or the application will not be processed. o All grades from in-progress prerequisite classes taken at other schools must be in the Allied Health Admission office one week after the grade has been posted. Students will be notified within a month of the close of the application period of their acceptance status, and s with the top points will be conditionally accepted and invited to a mandatory MA new orientation. o At the orientation session, s will be evaluated on their oral communication skills. Official Acceptance will be sent after the MA new orientation has been successfully completed. At that time, any s who have taken MA program coursework a college other than Portland Community College will need to order official transcripts and have them evaluated by Student Records Application Evaluation Students will be given points using the point system and rubrics listed on the MA admission website In the event s have the same number of admission points, ties will be broken based on the date of application, so it is to your advantage to get your application turned in as early as possible. Two people will read all essays and supplemental questions for evaluation purposes, and the number will be the average of the two evaluations. Medical Assisting Program Application Page 2 of 7

3 STATEMENTS OF UNDERSTANDING Please initial each statement and sign below I understand that the Medical Assisting program is a full time, day program that may include coursework at multiple campuses and practicum locations. I understand that I am required to have reliable transportation to my clinical practicum sites, and that placement at clinical sites will be determined by the Medical Assisting faculty. I understand that I must earn at least a C in all program related courses. I understand that if I earn less than a C in any program related course, I will be dismissed from the program. I understand that after admission to the program I will be required to complete some or all of the following: criminal background check, proof of immunizations, and a ten-panel drug screening. I also understand that laws and clinical site requirements are subject to change, and that PCC may have very little to no influence on this process. If I am unable to pass the background check and drug screen required by the sites at the time I am scheduled for directed practice, or provide proof of immunizations from a licensed healthcare professional, I may need to find my own practicum site. This may limit my ability to complete my clinical rotations, graduate from the program and be employable. I understand that there will be additional costs, including, but not limited to, uniforms and supplies, criminal background checks, random drug screening, immunizations, and the national certification exam application fee. Signature of Student ESSAYS Write your essays on supplemental paper and attach to your packet. Essays should be words each. Essays are worth up to 5 pts each. See Advising Guide for rubrics. 1. Why are you interested in becoming a Medical Assistant? 2. What role do you imagine diversity plays in the medical assisting field? Tell us about experience you have had treating people equally and including all people. Medical Assisting Program Application Page 3 of 7

4 SUPPLEMENTAL QUESTIONS Provide as much information as possible below. If you need more space for these questions, feel free to attach a supplemental document, and title it SUPPLEMENTAL QUESTIONS ADDENDUM. This information must be verifiable and is worth up to 4 pts per question. See Advising Guide for rubrics. 1. What experiences have you had working or volunteering in the health field? Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more 2. What experiences have you had using the computer, including using programs such as Microsoft Office Suite, Google Applications and other software? This could include coursework. If so, explain the class and how it was used. Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more Medical Assisting Program Application Page 4 of 7

5 3. What experiences have you had with customer or public service? Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more 4. What experience have you had volunteering in the community that differs from those listed in the previous sections? This can be anything that shows that you have given back to your community. Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more Was this: Paid or Volunteer Total Hours Worked/Volunteered: or more Medical Assisting Program Application Page 5 of 7

6 PCC Cascade Campus Allied Health Medical Assisting Program Recommendation Form To be completed by an employer, volunteer supervisor, counselor or instructor. This is seeking admissions to an Allied Health program at Portland Community College, Cascade Campus. Please fill the evaluation form out completely. You may be contacted to verify the information provided. Please place in a sealed envelope and sign across the closure. Applicant can include sealed envelopes with the Allied Health application or you can mail to the following address separately. Thank you. Portland Community College Allied Health Admissions, CA TEB N. Killingsworth St. Portland, OR Student Information Student Name Evaluator s Name Evaluator s How do you know this Ratings Evaluator s Phone Number How long have you known this No Basis for Comment 1 = Poor 2 = Fair 3 = Satisfactory 4 = Good 5 = Excellent Knowledge/Preparation Work Quality/Organizational Skills Attendance/Punctuality Initiative Communication/Listening Skills Dependability/Reliability Emotional Maturity/Stability Judgment/Analytical Ability Evaluation Additional Verification of Recommendation Evaluator s Signature Medical Assisting Program Application Page 6 of 7

7 PCC Cascade Campus Allied Health Medical Assisting Program Recommendation Form To be completed by an employer, volunteer supervisor, counselor or instructor. This is seeking admissions to an Allied Health program at Portland Community College, Cascade Campus. Please fill the evaluation form out completely. You may be contacted to verify the information provided. Please place in a sealed envelope and sign across the closure. Applicant can include sealed envelopes with the Allied Health application or you can mail to the following address separately. Thank you. Portland Community College Allied Health Admissions, CA TEB N. Killingsworth St. Portland, OR Student Information Student Name Evaluator s Name Evaluator s How do you know this Ratings Evaluator s Phone Number How long have you known this No Basis for Comment 1 = Poor 2 = Fair 3 = Satisfactory 4 = Good 5 = Excellent Knowledge/Preparation Work Quality/Organizational Skills Attendance/Punctuality Initiative Communication/Listening Skills Dependability/Reliability Emotional Maturity/Stability Judgment/Analytical Ability Evaluation Additional Verification of Recommendation Evaluator s Signature Medical Assisting Program Application Page 7 of 7