Health Information Management Program Application
Questions? Contact the program director.
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Full name
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Miss
Mr.
Mrs.
Ms.
Dr.
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Student ID (SISID)
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Address
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Street Address 1:
Street Address 2:
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City:
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State:
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Zip:
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Daytime phone
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Evening phone
Cell phone
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Date of birth (mm/dd/yyyy)
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/
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E-mail
Have you ever applied to a TCC Health Professions program before?
Yes
No
I have had healthcare experience.
Yes
No
I am a high school graduate or have completed a GED.
Yes
No
I have been to counseling and taken the Math and English placement tests.
Yes
No
I have passed Math 03 or higher, or taken a college math course.
Yes
No
I have passed Biology 141 with a C or higher.
Yes
No
I'm currently enrolled in Biology 141
Other courses I am currently enrolled in or have taken
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
My transcripts are
Choose...
Currently at TCC
On their way to TCC
N/A
Other
Do you wish to attend HIM classes full-time or part-time?
Full-time
Part-time
Have you attended an HIM open house in the last year?
Yes
No
Brief statement of interest in Health Information Management (<100 words)
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Security Question
3 + 7 =
