Medical Assistant Program Application CHECK LIST 2014

MEDICAL ASSISTANT PROGRAM APPLICATION CHECK LIST 2014

Application Instructions Use this document as a check list when gathering information for your application. You will submit your application, immunization records, and essay via the Medical Assistant Application Portal in Canvas by 5:00 pm on June 1. The applicants accepted into the Medical Assisting Program will receive an acceptance letter with New Student Orientation and background check information by July 1st. Students that are not accepted will also receive letters by July 1st.

STEP 1 APPLICANT DEMOGRAPHIC INFORMATION

Full Name:

Peninsula College Student ID Number:

Current address:

City: State: ZIP Code:

Home Phone: Cell Phone: Work Phone:

Email Address:

I have a High School Diploma Yes ☐ No ☐

I have a GED Yes ☐ No ☐

I have attended Peninsula College in the past. Yes ☐ No ☐

I have a degree in another discipline Yes ☐ No ☐

List degrees and certificates you have earned. Include the name of the College or University.

1 STEP 2 REQUIRED IMMUNIZATIONS

Students should scan their paper documentation and submit their immunization records as pdf, tiff or jpeg files. Check if complete. Students can contact the Computer Lab for help. Applicants are required to submit http://www.youtube.com/watch?v=GMBhcSkmm6A proof of immunization electronically through the Canvas http://www.youtube.com/watch?v=mFUyuJ6AmM8 drop-box. http://www.youtube.com/watch?v=LC5kCujANH8

1) Hepatitis B – record of series of three injections Yes ☐ No ☐ OR titer that demonstrates immunity.

2) Measles – record of two doses OR titer that Yes ☐ No ☐ demonstrates immunity.

3) Mumps – record of two doses OR titer that Yes ☐ No ☐ demonstrates immunity.

4) Rubella – record of two doses OR titer that Yes ☐ No ☐ demonstrates immunity.

5) Tetanus – record of booster dose (TDaP) within Yes ☐ No ☐ ten years OR titer that demonstrates immunity.

6) Varicella – record of two doses OR titer that Yes ☐ No ☐ demonstrates immunity.

7) PPD – annual TB skin test documentation. If positive, student must obtain a chest x-ray with written results or signed statement from a healthcare Yes ☐ No ☐ provider stating student is asymptomatic and poses no danger to patients.

8) Influenza – annual influenza immunization Yes ☐ No ☐ required.

STEP 3 PERSONAL ESSAY INSTRUCTIONS

2 Instructions Answer the following questions in essay form on a separate document. Please make sure each part of the questions are addressed in your answers. Use Times New Roman, 12 point font and double space the body of the essay. Save your work as a doc or docx file and submit it through the Canvas drop-box.

1) Why do you want to attend the Peninsula College Medical Assisting Program?

2) Have you worked in the medical profession? If the answer is yes, where and when, and in what capacity?

3) What are your goals for the next two years?

4) What are your educational goals? (For example, earn a degree or certificate, prepare for a job, or personal enrichment).

5) How do your goals involve team work?

If you have questions call Rachel Pairsh at (360) 417- 6414 or email [email protected]