Medical Office Programs Application

Personal Information
Medical Office Programs Application
First Name:	(required)
Middle Name:
Last Name:	(required)
E-mail Address:	(required)
Home Phone Number:	(required)
Cell Phone Number:
Address:	(required)
City:	(required)
State:	(required)
Zip:	(required)

Educational Background
High School:	Year Graduated: (required)
College:	Hours Completed:
Degree:	Year Graduated:
Other Education (describe):

Work Experience:
Describe your work experience, particularly any experience you might have in healthcare:
Program Schedule selection: Medical Office Procedures Certificate Program Medical Coding Certificate Program Medical Coding AAS Degree Program Medical Transcription Certificate Program Medical Transcription AAS Degree Program I verify that all of the information provided is, to the best of my knowledge, accurate. I also acknowledge that a criminal record check will be required in the future if I complete my field work experience in a hospital setting at a JCAHO facility. I also acknowledge that I will complete a program final examination as written by the Cowley College Medical Office Division Advisory Committee. *Incomplete applications will not be considered.

Official transcripts for high schools and colleges must also be sent to our registrar.