Medical Assistant Program Interest Form

Medical Assistant Program Interest Form

To start Medical Assistant Clinical Courses, you must begin the screening process by August 1.
Student Information

Please make sure the information provided is accurate.
Name*

First NameLast Name
Student ID
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email *

Additional Information
Do you have college credits you'd like to transfer to Mid?*

YesNo
Do you have Previous Health Care Work or Volunteer Experience? Select all that apply.*

Yes - Health Care Work ExperienceYes - Volunteer ExperienceNo
For transfer students, list all colleges where you are transferring prerequisite coursework from.
Example: Central Michigan University, Lansing Community College
Number of credits successfully completed at Mid Michigan College.
This only includes successful course work taken at Mid, not transfer credits. You can view your total Mid credits on MidWeb.
I have a previous earned degree.

Yes - Complete next questionNo - Click to Next page
Degree Earned and Institution Degree Received (If Applicable)
Example: Associate Degree in General Studies from Mid Michigan College.
Upload proof of Health Care Work or Health Care Volunteer Experience

Upload a File
If applicant has prior health care work or volunteer experience, the applicant MUST upload documentation of job description/or volunteer experience, length of service, and hours per week from supervisor on agency letterhead. Applicant must be working for a minimum of four (4) months in the past five years. Volunteer experience must be for a minimum of 40 hours in the past two years. In home care of family/friends is not accepted as volunteering. Cancelof
Personal Statement

A brief account of:
1. Significant experiences, activities, and employment.
2. Your reasons for considering a career in Health Sciences.
3. How your medical office observation (recommended) related to you reasons for selecting a career in Health Sciences.
4. Your plans and aspirations for the future.
The personal statement is to by typed on a seperate document, should be a maxiumum of one page in length, and uploaded below.
Upload Personal Statement

Upload a File
The personal statement is part of the selective admission criteria, and therefore, does affect your prospects for admission. Please refer to the Personal Statement Evaluation Rubric found on the Medical Assistant website and in the information packet. Cancelof
By checking this box I certify that my answers are true and complete to the best of my knowledge. I am responsible for assuring all documents are received and all required documents are completed. Late documents are not accepted for consideration.*

I agree to and understand this statement
Final acceptance into the Medical Assistant Program is pending a clear criminal background check and drug screening. These tests are completed at the students expense.*

I agree to and understand this statement
By checking this box, I understand immunizations are required for the Medical Assistant Program.*

I agree to and understand this statement
If selected for admission, I would prefer to have my courses and labs for the Medical Assistant Program at the following location. (Please note that this cannot be guaranteed.)*

Harrison CampusMt. Pleasant CampusEither Campus
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Medical Assistant Program Interest Form

Student Information

Additional Information

Personal Statement