APPLICATION GUIDELINES

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1 MODESTO JUNIOR COLLEGE 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 or in person at Enrollment Services on either campus: East Campus - Student Services building 102, or West Campus Yosemite Hall 147, 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 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 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 Glacier Hall, Room 165 February 1 through April 15 th Please note, if the Program is not full, applications will continue to be accepted until August 15 th.

2 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.

3 MODESTO JUNIOR COLLEGE 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 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:

4 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 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 Eligibility for ENGL 50: Basic Composition and Reading on assessment test. Course Test Date MATH COMPETENCY MATH 20: Pre-algebra (C or better) or Course Eligibility for MATH 70: Elementary Algebra on assessment test. Test Date READING COMPETENCY READ 184: Critical Reading (C or better) or Course 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 I hereby certify under penalty of perjury the foregoing statements are true and correct. Signature of Applicant Date

5 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 (if any) OFFICE USE ONLY:

6 MODESTO JUNIOR COLLEGE 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 sent to the MJC student 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: SIGNATURE DATE RECEIVED TRANSCRIPTS RECEIVED PLEASE REVIEW AND COMPLETE ALL ITEMS (INCLUDING ASSESSMENTS TESTS) BEFORE RETURNING APPLICATION TO. AN INCOMPLETE APPLICATION WILL NOT BE PROCESSED.

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