SAN JUAN COLLEGE
HEALTH INFORMATION TECHNOLOGY PROGRAM
ENTRY APPLICATION

Thank you for your interest in the Health Information Technology Program. Complete all information.

Date: * Applying For Semester/Year:
CONTACT INFORMATION:
* (Last) * (First) (Middle)
Former name(s) (maiden) that may identify transcripts
* Datatel #: * Phone# (Home):
* Mailing Address: * (Street)
* (City) * (State) * (Zip Code)
 
* SJC Live Student Email Address:
* SJC Student email ends in @my.sanjuancollege.edu. This email is the official form of communication between San Juan College facilitators and students and thus a required field.
Personal Email Address:

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:

NAME CITY STATE DATES 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 HIT PROGRAM:

Prerequisite Course Completed courses
COMM111 Interpersonal Communication(or COMM110)
ENGL111 Freshman Composition (or ENGL 118)
ENGL218 Advanced Technical Writing (or ENGL211)
HITP110 Medical Terminology
HITP112 Human Body Structures and Functions
HITP116 Computerized Business Applications
MATH114 Math for Health (or MATH115, or MATH160 or higher)
PSYC120 Intro to Psychology
How Did You Hear About Our Program?:
AHIMA/CAHIIM Current Student/Graduate
Career/College Fair San Juan College Website
Other

Why Are You Interested In The Program?:

Experience:
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 Health Information Technology 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.

* Signature: Date:

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 in instructional programs and activities.