Transforming Lives Building Communities Funeral Service Education Application Fall 2018 Open date: July 2017 Applicants can begin submitting program applications. Close date: Friday, March 30, 2018 All required documentation listed on the application checklist must be received by the Admissions, Registration and Records office no later than 5 p.m. No postmark date allowed, no exceptions. No incomplete or late submissions will be considered. Please note: This application is for a restricted entry program and must be hand signed and submitted along with supporting documents and payment. People requiring accommodations due to disability should contact the Disability Services Office at 503-491-6923 or dsoweb@mhcc.edu. Submit by Mail: Submit in Person: Mt. Hood Community College Admissions, Registration and Records Funeral Service Education 26000 SE Stark St Gresham 97030 Student Services (room AC2253, Gresham Campus) DO NOT include this page with your application materials.
Fall 2018 Admission APPLICATION PACKET CHECKLIST Every item on this checklist needs to be submitted by the application deadline, Friday, March 30, 2018, 5 p.m. Only completed applications containing all the required documents will be considered for review. Incomplete or late applications will not be considered. It is the applicant s full responsibility to make sure everything was received by the deadline. By signing below, I am confirming each item on this checklist is included with my application or I have confirmed they are already on file at MHCC. I understand it is my sole responsibility to submit the required documents, and I will not be given notice if my application is incomplete until after the deadline, at which time it will be too late to submit missing documents. 1. General Admissions Form, Apply Online at my.mhcc.edu/ics/admissions and select General Studies as your major. It will change to Funeral Service if/when you are admitted to the program. 2. Application Packet Checklist Page 2 3. Health Professions Division Application Page 3 4. Educational Planning Chart (second year applicants only) Page 4 5. Funeral Service Education Program and Industry Disclosure Acknowledgement Page 5 6. Official (in a sealed envelope) High School or GED Transcript showing an overall Pass score. This requirement may be waived if you have completed 9 semester credits or 13.5 quarter credits of college level courses (excluding developmental courses) from a regionally accredited school, with a cumulative GPA of 2.0 or higher. 7. Letter from Apprenticeship Provider or Related Work Experience Signed by Supervisor. 8. $25 Non Refundable Application Fee Make check payable to MHCC. Bank card/cash is only payable in person in Student Services (room AC2253). 9. Driver s License: A clear and legible photocopy of your valid driver s license must be included with your application packet. 10. Official (in a sealed envelope) College Transcript(s) from ALL SCHOOLS ATTENDED (except MHCC) documenting college coursework and prerequisite requirements. This includes AP/IB official transcript/scores. 11. MINIMUM PREREQUISITE REQUIREMENT: I have met the writing and math requirement by completing: q Writing (choose one): MHCC College Placement Test Score (cannot be older than 3/30/2013) with placement into WR115 Mathematics (choose one): q MHCC College Placement Test Score (cannot be older than 3/30/2013) with placement into MTH060 q Placement test scores (cannot be older than 3/30/2013) from: q Completion of WR090 or higher with a C grade or better. List course here: q Placement Test Scores (cannot be older than 3/30/2013) from: q Completion of MTH020 or higher with C grade or better. List course here: 1. MHCC s Admissions, Registration and Records office will send all application notifications by email. It is your responsibility to set your spam filter system to accept email addresses containing @mhcc.edu. Do this even if you are currently receiving emails from MHCC. We cannot be responsible for notices that are not received due to spam or junk mail handling. Make sure to add MHCC to your safe senders list. 2. I understand it is my responsibility to ensure all items are received by the application deadline and that only complete applications will be evaluated for admission. Furthermore, I have read and understand the admission requirements and procedures for applying. I understand that withholding information or giving untruthful answers to questions on this application could be cause for non-acceptance or dismissal from the program. Printed Name: MHCC ID: Signature: Date: / / Mt. Hood Community College Rvsd 072517 Page 2
FUNERAL SERVICE EDUCATION HEALTH PROFESSIONS DIVISION APPLICATION Please print and complete fully, do not leave blank. Attach extra paper if needed. Name: MHCC ID: Previous Last Name(s): Date of Birth / / Email (ALL notifications will go out via email to this address): Month Day Year Current Mailing Address: Street City State Zip Phone Number and Alternate Phone: ( ) ( ) Home Cell Racial / Ethnic Information (Your response is voluntary): Do you consider yourself to be Hispanic or Latino: Yes No In addition, select one or more of the following racial categories to describe yourself: American Indian or Alaskan Native Asian Native Hawaiian or Other Pacific Islander African American or Black White Name of Nearest Relative and Their Relationship to You: Address of Named Relative Name Relationship (i.e., Mother) Street City State Zip How did you hear about the program? Education Record: What is your high school education? High School Diploma GED Did Not Complete List ALL colleges attended. Omission of any college transcript will result in non-admittance or dismissal from the program. College Major Degree earned or number of credits completed Date of completion Work Experience: List any experience that relates to Funeral Service or customer service. Letters of reference and/or resumes are important to your application and acceptance consideration. Please provide names, addresses and dates of employment for funeral home(s) or related experience. Funeral Experience: Customer Service Experience: Extras Please note any that apply: I have been a registered apprentice in the state of for months. I have assisted in the embalming of remains and funeral services. Do you have any relatives working in the field? Check all that apply: Father Mother Brother Sister Grandparent Uncle Aunt Child Other Mt. Hood Community College Rvsd 072517 Page 3
SECOND YEAR EDUCATIONAL PLANNING CHART (Students applying for FIRST year admission do not need to submit this form.) Printed Name: MHCC ID: Students who are applying for SECOND year admission are REQUIRED to complete the information for all of the courses outlined below. Fill the form out in its entirety, DO NOT leave boxes blank. For acceptance as a SECOND year student, all courses must be completed with a C grade or better by the end of Summer term 2018. Updated official transcripts must be received on or before September 14, 2018. If the class is currently in progress, put IP in the GRADE box. Indicate the TERM/YEAR in which the course is being taken or will be completed if not yet taken. List courses as they appear on your transcript for courses not taken at MHCC. Do not use the MHCC equivalency, convert to quarter credits, or include +/- on your grades (i.e., B- = B). NON FUNERAL SERVICE EDUCATION PREREQUISITE COURSES AC110 General Accounting I 1 AH110 Medical Language for Healthcare Settings MO114 Medical Terminology I BA226 Introduction to Business Law BI100 Survey of Body Systems BI121 Essentials of Human Anatomy and Physiology I BI231 Human Anatomy and Physiology I CH104 General, Organic and Biological Chemistry I CH112 Chemistry for Health Professions 2 CH151 Basic Chemistry CH221 General Chemistry 1 BA131 Introduction to Business Computing CIS120 & CIS120L Computer Concepts I (with Lab) Any HE, HPE or PE Course (3 credits) MTH065 Beginning Algebra I PSY201 General Psychology PSY202 General Psychology COMM100 Basic Speech Communication COMM111 Fundamentals of Public Speaking COMM115 Introduction: Intercultural Communication COMM218 Interpersonal Communication COMM219 Small Group Communication PSY101 Psychology of Human Relations WR121 English Composition COURSE GRADE CREDITS TERM/YEAR COLLEGE/ UNIVERSITY 1 AC110 is the recommended course to take. However, if students have already completed BA211, it can be substituted for AC110. 2 CH112 is formerly CH103 at MHCC. Mt. Hood Community College Rvsd 072517 Page 4
FUNERAL SERVICE EDUCATION PROGRAM AND INDUSTRY DISCLOSURE ACKNOWLEDGEMENT By signing below, I am confirming I have read and agree to abide by the following statements: Important Note: Some external links may be inaccessible. People requiring accommodations due to disability should contact the Disability Services Office at 503-491-6923 or dsoweb@mhcc.edu. I understand all Funeral Service Education curriculum courses must be completed with the grade of C or better. I understand to be admitted to the FSE program as a second year student, all non-fse coursework must be completed before the start of the designated Fall term and with a C grade or better. I understand previous criminal and vehicle convictions may prevent applicants from being able to obtain an intern license (required for FSE240 & FSE240A), from finding work in the industry, or from being licensed as funeral directors or embalmers. To receive an intern license, apprentice license, embalmer or funeral director s license, the state board in which you are applying may conduct a criminal background check. I have read the Funeral Service Education (FSE) Student Handbook, specifically the academic expectations, dress and hygiene codes and other FSE student requirements, with which I will comply. I understand it is my responsibility to understand the licensing requirements for the state in which I intend to practice. I understand any correspondence regarding my Funeral Service Education admission process will be via email. I accept and agree to comply with all curriculum and program requirements. I acknowledge that the Oregon Mortuary and Cemetery Board regulates Death Care Facilities and Practitioners in Oregon. Oregon Administrative Rules (OAR) Chapter(s) 830 and Oregon Revised Statutes (S) 692 are fully explained on the web pages listed below. Furthermore, I acknowledge that the Washington Department of Licensing is the regulatory authority overseeing policies for the WA Funeral and Cemetery Board. http://www.oregon.gov/mortcem/pages/laws_and_rules_june_11_2004.aspx http://www.dol.wa.gov/business/funeralcemetery Printed Name: MHCC ID: Signature: Date: / / Mt. Hood Community College Rvsd 072517 Page 5