HEALTH INFORMATION MANAGEMENT PROGRAM APPLICATION

Questions? Contact the program director.
Full Name * Required
Prefix First Last Suffix
Student ID (SISID) * Required
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Daytime Phone * Required
Other Phone
Date of Birth - must be mm/dd/yyyy format
MM slash DD slash YYYY
Email * Required
I have healthcare experience. * Required
- Yes
- No
I am a high school graduate or have completed a GED. * Required
- Yes
- No
I have been to counseling and taken the Math and English placement tests. * Required
- Yes
- No
I have passed MTE 5 or higher, or taken a college math course. * Required
- Yes
- No
I have passed Biology 141 with a C or higher. * Required
- Yes
- No
Other courses I am currently enrolled in or have taken: (check all that apply) * Required
- Medical Terminology I, HLT 143
- Medical Terminology II, HLT 144
- Introduction to Computer Applications and Concepts, ITE 115
- Orientation to Healthcare, SDV 101
- College Composition I, ENG 111
- Introduction to Psychology, PSY 201
- Practical Reasoning, PHI 115
- Other
- N/A
My transcripts: * Required
Do you wish to attend HIM classes full-time or part-time? * Required
- Full-time
- Part-time
- Not yet decided
Have you attended an HIM open house in the last year? * Required
Please briefly tell us about your interest in TCC's Health Information Management program.
Type the characters from the image below.

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