College Admissions Form

Lincoln University: Medical Assisting Training Program

Grant Funded
Thank you for your interest in the Medical Assistant Program! This program is for Philadelphia residents who are interested in intensive training and certification for the role of Medical Assisting. It is for individuals who are interested in pursuing full time employment after they complete training and certification. After successful completion of the program, we connect you with our employer partners for interviews. While we cannot guarantee jobs, we can guarantee an interview. The goal of the program is for you to enter long-term employment as a Medical Assistant.

Typically, new Medical Assistants make $19 - $21 per hour. This role is patient-centered. Ideal candidates enjoy caring for others, have strong customer service and communication skills. This is a 10-week, accelerated program. Only apply if you can commit to the full training schedule that will run from 9:30 am to 2:30 pm, Monday – Friday, 4/14/25 -6/20/25

Your application will take 30 minutes to complete.

Important: you may receive emails inviting you to schedule testing and virtual interviews within 2-4 days after you submit your application. Please check your email frequently for invitations and updates.
Demographic Information
Name*

Legal First NameMiddle Initial (Enter n/a if no middle name) Legal Last Name
Preferred Name
What is your race/ethnicity?*
Birth Date

MonthDayYear
Phone*
E-mail Address*
example@example.com
Legal Sex?*
Are you a U.S. Citizen?*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you ever been convicted of a crime?*
A criminal background check is required but it does not exclude you from participation in this program.

Eligibility Criteria
Do you live in the City of Philadelphia?*
Do you have a High School Diploma or G.E.D.?*
Must be able to provide a copy of GED or diploma
Are you 18 or older?*
Must be able to provide proof of age (i.e. state identification card, driver's license)
Upload proof of identification*

upload: passport, state identification card or driver's license)
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Are you eligible to work in the United States?*
Are you currently working?*
If so, what is your current occupation?
Would you describe yourself as being unemployed or under-employed?
Under-employed means you work less than full-time or don't earn enough to support your household.
Are you able to commit to attending every day of the 10-week program that runs Monday-Friday, 9:30am to 2:30pm, April 14th - June 20th 2025?*
Can you commit to completing 5-10 hours of homework and studying outside the class from April 15 - June 20*
Can you commit to seeking full-time employment, with our support, immediately following your completion of the program?
Referral Source:
How did you hear about the program?

Education
Please tell us about any academic experience, even if you have not yet earned a degree/certification. Applicants must have a high school diploma or GED and provide proof prior to enrollment. If you have additional education experience, please click “add another response” below to tell us about it.
High School or Equivalent Name*
Last Date Attended

MonthDayYear
Date
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Course of Study
Which degree did you receive*
If other, please list the name of your degree.

Additional Education

If you do not have any additional education experience please select next to move on in the application
School Name
Course of Study
Years Completed
Last Date Attended

MonthDayYear
Date
Which Degree did you receive?

Professional Certification
School/Training Provider
Type of Certification/License
License Number
Certification Issued by:
Expiration Date:

MonthDayYear
Date

Employment History
Company Name
Phone Number
Please enter a valid phone number.
Supervisor's Name
Supervisor's Title
Your Job Title
Hourly Wage ($/hr)
# Hours Worked per Week
Date of Hire

MonthDayYear
Date
Date of Exit

MonthDayYear
Date
Reason for Leaving
If applicable, please explain why you left this job

Employment Gaps
Please account for any full month since leaving High School or College that you were not working
From

MonthDayYear
Date
To

MonthDayYear
Date
Reason

Qualifications
Please use this space share to any additional information (skills, education, training, certification, etc.) that you did not share elsewhere in this application

Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to entry into the program, I understand that false or misleading information in my application or interview may result in my release from the program.
Signature

Clear

Application Essay Questions
How does the Medical Assistant Program align with your career goals and interests?
What interests you in becoming a Medical Assistant?
Why do you believe you are an ideal candidate for this grant funded training opportunity?
What do you consider to be your professional and personal strengths?

Program Description
In the Medical Assistant Program, participants will actively engage in professional skills development, technical skills training, career services support and career coaching. The technical skills training will prepare you for all aspects of becoming a proficient Medical Assistant in a doctor’s office, hospital or lab. It includes the hands on, clinical skills and the classroom, academic learning, required for you to pass national certification exams.

In this program, we offer:
- No-cost Medical Assistant training and the opportunity to sit for national certification exams. Certification is required to become employed as a Medical Assistant.
- Professional skills development and career services support; including resume writing, interview skills preparation and employment application support.
- Connection to our employer partners for an interview opportunity for full time employment.
- If you are hired, the opportunity to earn $19 to $21/hour with benefits, as an entry level Medical Assistant.
Thank-you for your application! You will receive an email within 2 to 5 days notifying you of next steps.

Please plan to attend an Information Session on 3/20/25 at 12:00pm or 3/24/25 at 6:00 pm.

Click here to Register: << Insert Edison’s Google Form Link here>>
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Lincoln University: Medical Assisting Training Program

Demographic Information

Eligibility Criteria

Referral Source:

Education

Additional Education

Professional Certification

Employment History

Employment Gaps

Qualifications

Disclaimer and Signature

Application Essay Questions

Program Description