Thank you for your interest in the Medical Coder/Biller Program. Complete all information.
Education:Check highest level completed: GED High School Diploma Associate Degree Other (specify):
Please list the name and the location of each college previously attended:
Official transcripts must be requested from colleges and universities previously attended to transfer credits.
Have transcripts sent directly to the San Juan College Admissions and Records Office. Transcripts will be evaluated by Admissions and Records ONLY UPON FORMAL
REQUEST BY THE STUDENT.
PREREQUISITE COURSES MUST BE COMPLETED (OR IN PROGRESS) BEFORE APPLICATION TO THE CODER/BILLER PROGRAM:
How Did You Hear About Our Program?:
Briefly describe any previous health information or health related work or volunteer experience.
List CCS, CCA or any other professional credential(s) that you already hold.
CRIMINAL BACKGROUND CHECKS:
Please note CRIMINAL BACKGROUND CHECKS are required by state and federal law.
I understand that as as student in to the SJC Medical Coder/Biller Program, I WILL be required to have a criminal background
check completed as a mandatory requirement for the Professional Practice Experience (PPE), and results will be provided to the SJC HIT
Department. I further acknowledge that there may be a fee for this, which I will be responsible for.
I certify that the information provided in this application is true and complete to the best of my knowledge.
San Juan College does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, handicap/disability, age,
or Vietnam era/disabled veteran status in employment or in the application, admission, participation, access and treatment of persons ininstructional programs and activities.