APPLICATION GUIDELINES

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MODESTO JUNIOR COLLEGE ALLIED HEALTH

MEDICAL ASSISTING PROGRAM APPLICATION GUIDELINES

It is the applicant's responsibility to make sure that steps 1-5 below have been completed. 1. Admission to Modesto Junior College (MJC).

You can apply for admission at www.mjc.edu or in person at Enrollment Services on either campus: East Campus - Student Services building 102, 209-575-6853 or West Campus – Yosemite Hall 147, 209-575-7727.

2. Complete the MJC Assessment Test requirements, prior to Program application deadline.

3. Official transcript showing high school graduation or documentation of a GED or college degree must be submitted with your program application to Allied Health by the

Program application deadline unless documentation is already on filed in the MJC

Enrollment Services. Your application will not be processed without this documentation. Applicants who attended high school in another country must have their high school

transcript evaluated by the International Education Research Foundation (IERF), Inc. or another approved document evaluation service. For more information, contact IERF at

[email protected] 310-258-9451 or contact MJC Enrollment Services for a list of approved document evaluation services. If you cannot verify your high school

graduation, you may take the GED examination. For information on the GED, contact the Stanislaus County Office of Education at 209-558-8694.

4. If you have attended any college(s) other than Modesto Junior College or Columbia College, official college transcripts must be submitted with your program application to Allied Health by the application deadline unless they are already on file in the MJC Enrollment Services. You should have someone from Allied Health or Enrollment Services initial the Transcript Verification Form included in your application packet to verify that your transcripts are already on file or to verify receipt of your transcripts. Only official transcripts submitted by the application deadline will be used to determine program eligibility. It is the applicant’s responsibility to assure that all transcripts are on file and up-to-date. We will accept hand-carried transcripts that are in a sealed

envelope with a school seal.

NOTE: Students submitting transcripts from colleges out of district or from any college prior to 1995 must provide course descriptions on coursework required for the medical assisting program. A copy of the cover of the catalog for the year the course was taken must be included along with the course description from that catalog.

5. Application may be mailed to: or Submitted in person to:

Modesto Junior College MJC West Campus

Medical Assisting Program Allied Health

435 College Avenue Corner of Carpenter & Blue Gum

Modesto, CA 95350 Glacier Hall, Room 165

February 1 through April 15th

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ATTENTION MODESTO CITY SCHOOLS (MCS) ROP APPLICANTS ONLY! If you are a MCS ROP applicant, you need to complete the following two steps in addition to the standard program application procedures:

1. At the top of the Medical Assisting Program application, check "I am a Modesto City Schools ROP applicant.”

2. Make sure that you have a Modesto City Schools transcript showing that you completed the Medical Clerical ROP course with a grade of B or better. Two year recency is required.

3. Accepted Applicants will need to submit a Certificate of Completion for the Modesto City Schools ROP Medical Clerical course to the Medical Assisting Program Director.

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MEDICAL ASSISTING PROGRAM PROGRAM APPLICATION

Please check the appropriate statement(s) below:

___ I am interested in the certificate program only.

___ I am interested in the certificate program and obtaining my A.S. Degree. ___ I am a Modesto City Schools ROP applicant.

Modesto City Schools Modesto Junior College

Downey High School Allied Health

ROP Program Medical Assisting Program

Course: Medical Office 1-2 Course: Medical Assisting 322

======================================================================= ___ Female ___ Male ___ U.S. Citizen ___ U.S. Veteran

PLEASE TYPE OR PRINT

___________________________________________________________________________ Legal name Last First Initial Previous/maiden name

___________________________________________________________________________ Legal address Number Street City State Zip

___________________________________________________________________________ Mailing address Number Street City State Zip

___________________________________________________________________________ MJC student email address (required) Student ID Number (required)

Home phone Cell Phone Date of Birth ___________________________________________________________________________

Employer Work phone

Person to be notified in an emergency:

___________________________________________________________________________ Name Relationship Daytime Phone

Are you currently enrolled at Modesto Junior College? YES NO

Do you plan to apply to another MJC Allied Health Program this year? YES NO

If yes, which program: _________________________________________________________

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PLEASE LIST COURSES THAT ARE CURRENTLY IN PROGRESS:

Course Number and Course Name Name of College

_________________________________ ________________________________

REQUIRED COURSEWORK THAT MAY BE COMPLETED PRIOR TO ENTERING THE MEDICAL ASSISTING PROGRAM

If you have taken or are currently taking any of the courses listed below (or their equivalents), indicate where and when:

___ ANATOMY AND PHYSIOLOGY _____________________________________

AP 50 College Semester/Year

___ MEDICAL TERMINOLOGY _____________________________________

MDAST 321 College Semester/Year

___ PSYCHOLOGY _____________________________________

PSYCH 51 or 101 College Semester/Year

___ COMMUNICATION STUDIES _____________________________________

COMM 100 or 102 or 130 College Semester/Year

RECOMMENDED COMPETENCIES:

WRITING COMPETENCY

ENGL 49: Basic English Skills (C or better) or __________________________ Course Sem/Year Eligibility for ENGL 50: Basic Composition and Reading

on assessment test. __________________________

Test Date MATH COMPETENCY

MATH 20: Pre-algebra (C or better) or __________________________ Course Sem/Year Eligibility for MATH 70: Elementary Algebra

on assessment test. __________________________

Test Date READING COMPETENCY

READ 184: Critical Reading (C or better) or __________________________ Course Sem/Year Reading competency of (85) on Accuplacer

on assessment test or __________________________

Test Date Completion of a college degree from a regionally

accredited college or university. __________________________

College Sem/Year I hereby certify under penalty of perjury the foregoing statements are true and correct.

__________________________________________ __________________________ Signature of Applicant Date

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MEDICAL ASSISTING PROGRAM ALLIED HEALTH

TRANSCRIPT VERIFICATION FORM

VERY IMPORTANT: THIS FORM MUST BE COMPLETED and submitted with your Medical Assisting Program application. Official transcripts from all colleges other than Modesto Junior College or Columbia College must be submitted with the Medical Assisting Program application unless they are already on file in the MJC Enrollment Services. Official high school transcripts or documentation of GED must be submitted unless you have a college degree documented on official college transcript.

___

Last Name (Legal) First Middle Previous/Maiden Name

___

Phone: Primary/Secondary/Other Student ID Number

High School (if Graduated) or GED location

Year of High School Graduation or GED

OFFICE USE ONLY: Initials Verifying Receipt

LIST ALL COLLEGES (including Columbia College.)

IMPORTANT: Official transcripts MUST BE submitted to Allied Health by the program application deadline, unless they are already on file in the MJC Enrollment Services.

Use the back of this form if you need more room.

Name of College:

Degree

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MEDICAL ASSISTING PROGRAM PROGRAM APPLICATION RECEIPT

This form is your verification that Allied Health has received your application packet. All completed application packets will be processed as quickly as possible after the closing date. All applicants will be notified of their acceptance status by email sent to the MJC

student email address. We regret we cannot project the date of notification, but you will be notified as soon as selection has been made. If you move and/or change your telephone contact information, please call and update your information. Please note that the US Postal Service does not forward mail from Modesto Junior College.

When you submit your application packet the person accepting your application packet will sign for it in the box below and stamp the receipt date. Please keep this form for your records.

MJC MEDICAL ASSISTING APPLICATION FOR: __________________________________________ APPLICANT NAME (PLEASE PRINT OR TYPE)

OFFICE USE ONLY – DO NOT WRITE IN THIS SPACE

RECEIVED BY:

_______________________________________ ___________________________________________ ALLIED HEALTH SIGNATURE ALLIED HEALTH DATE RECEIVED

TRANSCRIPTS RECEIVED

_________________________________________________ _______________________________________________

PLEASE REVIEW AND COMPLETE ALL ITEMS (INCLUDING ASSESSMENTS TESTS) BEFORE RETURNING APPLICATION TO ALLIED HEALTH. AN INCOMPLETE