Medical Assisting Certificate Program Application March 15 th May 31 st, 2018

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Thank you for your interest in the Allan Hancock College Medical Assisting Certificate Program. We are pleased that you are exploring Medical Assisting as a profession. Medical Assisting is a demanding discipline and the course of study is challenging as well as rewarding. The application period ends on May 31 st. A random lottery will take place in June for seating status, and an email notification will be sent no later than 4:00pm June 15 th, 2018 using the email address you provide on this application. Please review the contents of this application packet thoroughly prior to submitting your application and supporting documents. If you have questions regarding the Medical Assisting Certificate and/or specific questions about the application process, contact the Health Sciences Department at 805-922-6966 ext. 3384. PROGRAM The Medical Assisting Certificate Program is a two-semester program held during the day (starting in August and ending in May) that provides essential skills that are needed for employment in a medical office. If you are accepted into the program, all students must provide proof of being 18 years of age or older. A physical, complete immunization record with back-up paperwork, CPR certification, drug screen and background check are required to be completed prior to the start of the program to be in compliance with our medical facilities (Packet will be sent via email with your seating status once the lottery has been completed). A 5 week externship is required at the end of the spring semester. A grade of C or better in the medical assisting Fall classes are required to progress in the program for Spring. EMPLOYMENT OPPORTUNITIES The median hourly wage is $15.00 per hour. A medical assistant may work in private practice such as a medical office. Other areas of employment include community clinics and government agencies. CERTIFICATION OF ACHIEVEMENT Total of 26.5 units Allan Hancock College will offer a Certificate of Achievement, once the student has completed the mandatory classes. 1 st semester 14 units MA 305 Body Systems and Disease 5 (Can be taken in the Medical Billing Program, can not be repeated) MA 350 MA Fundamentals 2 MA 351 MA Clinical Procedures 1 3 MA 352 MA Administrative Procedures 4 (Can be taken in the Medical Billing Program, can not be repeated) * If you have previously taken the Medical Billing and Coding program at AHC, you will be able to apply to the program and will not have to retake the MA 305 and 352 classes. 2 nd semester 12.5 units MA 353 MA Clinical Procedures 2 5 MA 355 MA Pharmacology 4 MA 356 MA Job Success Externship 3.5 APPLICATION AND ADMISSION To apply for the Medical Assisting Program, you must submit a completed application. Please type or print clearly, if we can not read your application, it can not be processed. Incomplete applications will not be accepted. Applications are reviewed after application period ends. We use a randomized lottery system that will assign 30 students to the program. Students will be notified via EMAIL (email address provided on application) as to status in the program by the end of the day on June 15, 2018. The student will be REQUIRED to turn in the original acceptance statement for verification of acceptance in the program (please check your spam/junk email). A waitlist will only be maintained until the last day to add and will not carry over to the next application period. 1

APPLICATION ELIGIBILITY CRITERIA: Must be 18 years of age or older Must complete the following classes with a grade C or better OR you must be currently taking the following: Math 531 OR Math 521 ENG 514 OR Reading 110 COMPLETED APPLICATION CONSISTS OF: Program Application Form (you must have an student ID number in order to apply to the program) Provide proof of age, must be 18 years of age or older. A printout of your AHC unofficial transcripts (found on the myhancock portal, under Student Tab, my unofficial transcripts) showing proof of completion or current enrollment of Math 531 or equivalent or higher and Eng 514 or Reading 110 or equivalent or higher (your unofficial AHC transcripts will show all courses completed, transferred or in progress). If you completed one or more of these courses elsewhere, all official transcripts from other colleges must be turned in to the Admissions and Records Department, attention transcriber. Please allow 10 business days to be transcribed in time to turn in your application. UPON ACCEPTANCE INTO THE PROGRAM An email containing an acceptance letter will be sent out by the end of the day on June 15 th, 2018 to students seated in the upcoming class. This acceptance letter must be completed and turned into the Health Sciences office by the specified date. Items (Background Check, Immunizations, Physical, Drug Screening, CPR, Acknowledgement of Potential Risk/Substance Abuse Testing Form) that are contained within the Acceptance Letter Packet will be required to be completed and handed into the Health Sciences Office (M-132) by the specified date on the packet. It is the responsibility of the student to register and pay for all the Medical Assisting (MA) classes held in each semester by the deadline in the packet. ABSENT AND TARDY POLICY Class grade points are deducted for absences in excess of two (2) per semester. Three (3) tardies are considered a full day s absence. If you are not present when role is called, you are tardy. Missing 30 minutes of class or more during ANY part of class is considered a full day s absence. Do not make appointments during class time. There is no such thing as an excused absence. FINANCIAL AID For assistance with registration fees and cost of supplies please contact the Financial Aid office (x3216). CPR CARD The CPR card that is required for the program is Healthcare Provider (American Heart Association) OR Professional Rescuer (American Red Cross) OR EMS 306 (AHC). This card must be kept current and cannot expire during the program. (This is part of the acceptance packet) DRESS CODE Your appearance reflects the medical clinic and college standards and indicates to patients and co-workers your pride and interest in your profession. These standards are maintained by personal neatness and cleanliness, by wearing only the authorized uniform and by avoiding the use of elaborate jewelry and cosmetics. More information regarding uniforms will be in the emailed acceptance packet. 2

IMPORTANT: It is the responsibility of the facilities (Externship sites) to hold students to the same standards as an employee who has patient contact. The facilities have the final say as to whether a student may participate in patient care. It is not the decision of Allan Hancock College. Infractions, probations or pending court cases with a disposition date within 2 years showing up on backgrounds may result in non-admittance to or dismissal from the program. Felony convictions will result in non-admittance to the program. *It may take several weeks to complete the background check. You will be dropped if the background check is not started by the date on your acceptance packet. **BACKGROUND CHECKS: The Joint Commission of Hospital Accreditation and policies of our externship sites have required that any person having patient contact be screened for criminal convictions, and the results must be available to the care facility or medical clinic. ** Please remember to make a copy of your entire application packet prior to turning it in. Copies will not be made in the Health Sciences Office. Copy machines can be found in the library, student services or campus graphics. 3

Pre-Enrollment Expenses PHYSICAL EXAM Private physician Variable Cost IMMUNIZATIONS Hepatitis B Series, DPT, MMR, Varicella, Flu Vaccine, TB Variable Cost BACKGROUND CHECK Corporate Screening $48.00 DRUG SCREENING Roblar $30.00 FALL SKILLS KIT $90.00 est. CPR FOR HEALTHCARE PROVIDERS EMS 306 (½ unit) + $4 material fee + $15 textbook (AHC) $42.00 (AHC) Total is estimated excluding variable costs $210.00 Fall Semester TUITION (14 units @ $46/unit) $644.00 PARKING $20.00 HEALTH FEE, STUDENT CENTER FEES PLUS STUDENT REPRESENTATION FEE ($19+$10+$1) $30.00 REQUIRED FALL TEXTBOOKS $365.00 (est.) IDENTIFICATION NAME PIN $6.00 UNIFORMS (4 tops, 4 bottoms, 1 pair of shoes) $250.00 (est) WATCH (Not digital, must have seconds hand) $30.00 STETHOSCOPE (Prestige Medical/Littman s recommended) $30.00 ANEROID SPHYGMOMANOMETER (Prestige Medical/Littman s recommended) $30.00 MISCELLANEOUS SUPPLIES flash drive, notebooks, pens, paper, etc. $55.00 Total is estimated $1460.00 Spring Semester TUITION (12.5 units @ $46/unit) $575.00 PARKING $20.00 HEALTH FEE, STUDENT CENTER FEES PLUS STUDENT REPRESENTATION FEE ($19+$10+$1) $30.00 REQUIRED SPRING TEXTBOOKS $150.00 (est.) EXTERNSHIP COSTS (estimated transportation / gas costs) $150.00 MISCELLANEOUS SUPPLIES flash drive, notebooks, pens, paper, etc. $55.00 Total is estimated $980.00 TOTAL ESTIMATED COSTS TO ACHIEVE MEDICAL ASSISTING CERTIFICATE $2,700.00 (excluding variable costs) Prices are subject to change 4

This application will only be used for the 2018-2019 Medical Assisting class. Personal Information Full Name: Address: Last First M.I. Street Address Apartment/Unit # Primary Phone: Social Security or Tax ID Number: City State ZIP Code Secondary Phone: Birth Date: AHC Student # Email Address (Mandatory) Education Have you taken the Medical Billing program at Allan Hancock College previously? Date of Graduation Check boxes I have read this application packet carefully and agree to comply with the standards and rules detailed within; application process, completion of certificate guidelines, absent and tardy policy, and any other detailed information provided on this application packet. I will complete mandated items and turn in copies of forms as detailed in this application packet. I agree that I must submit proof, with this application, that I am 18 years of age or older for me to participate in the Medical Assisting Program. I understand that I must show proof of completion of pre-requisites with a grade C or better OR show proof of current enrollment OR start test scores showing above requirements. I understand that my official transcripts from ALL other colleges will be transcribed through Admissions and Records before I turn in my unofficial AHC transcripts showing completion of these pre-requisites. I understand that once I am accepted, a physical, proof of immunizations, background check and drug screening are required by the clinical facilities and not by Allan Hancock College. Infractions, probations or pending court cases showing up on the background check and/or a positive drug screen test may result in nonadmittance to or dismissal from the program. I understand that I will be notified via email no later than June 15 th, 2018 by the end of the day. It is my responsibility to write my email clearly, and check my spam/junk mail. If given a seat, the information packet will be emailed to the email address I have provided. If I am on the waitlist (maintained until the last day to add), I understand that I will be contacted via EMAIL/PHONE CALL as seats become available and I may not have very much time to respond. It is my responsibility to complete the packet within the timeframe specified upon notification. I certify that the statements made in this application are true and complete to the best of my knowledge and that any false or misleading information I may give, may be cause for denial of admittance. Signature Date Submitting an application does not guarantee that applicants have satisfied minimum criteria You may hand deliver this application packet to the Health Sciences office (M132) in Santa Maria or mail to: Attn: Health Sciences Department, 800 S. College Drive, Santa Maria, CA 93454 by the end of the application period (May 31, 2018). Please slide under the door if the door is closed. 5

Confidential Applicant Survey Federal and state mandates require that we compile summary data on the gender and ethnicity of applicants. To assist us in complying with this requirement we are requesting that you complete and return this form. It should be emphasized that it is the policy of Allan Hancock Joint Community College District that no person shall be discriminated against on the basis of race, color, ancestry, religion, gender, national origin, age, physical/mental disability, medical condition, marital status, or sexual orientation, information regarding the gender and ethnicity as applicants is not supplied to any other agency and is kept in a confidential file. Supplying the following information is optional and will not affect the status of your application. Name: Date: Program Applying For: 2018-2019 Medical Assisting Program Ethnic Background and Gender (please check only one): African American Asian Pacific Islander (Filipino) Hispanic American Indian Caucasian Other Asian Pacific Islander (non-filipino) Filipino Female Male I prefer not to provide this information 6

For Office Use Only Last Name AHC Student # H Application and Prerequisites Completed: Completed Program Application Confidential Applicant Survey Proof of age, must be 18 or older AHC Unofficial Transcripts Eng 514 or Reading 110 completed Currently enrolled Semester Math 531 or Math 521 completed Currently enrolled Semester Tested out or higher course work English Math Previous Medical Billing Student at AHC? YES NO Notes Office staff approval FOR OFFICE USE ONLY. STUDENTS MUST TURN IN ALL PAPERWORK AS DESCRIBED ABOVE 7