Health Information Technology Analyst Application Name * Required First Last Home or Cell Phone * RequiredWork PhoneHave you attended MECC before? * Required Yes No Preferred email: * Required MECC Student ID: If currently enrolled at MECC.Have you updated MECC Admission application in the last year? * Required Yes No Have you submitted high school and/or college transcripts? * Required Yes No Have you completed financial aid application? * Required Yes No Have you completed and submitted SAP appeal? * Required Yes No N/A Have you completed a statistics course? * Required Yes No Ex... MTH 155 or HIM 220Are you currently working in a health related field? * Required Yes No If so, please provide job title, employer's name and address: Employer Name Employer Address Street Address Address Line 2 City State / Province / Region ZIP Code and County Are you currently certified in an Allied Health field? * Required Yes No EX. RHIT, RHIA, PTA, RTH etc...If yes, please list certifications: Are you currently certified in a IT field? * Required Yes No EX. Computer Software Specialist, Networking, Computer Science etc...If yes, please describe: Please list all colleges attended since high schoolLast college attendedStateDegree ReceivedLast year attended Academic Standing at Last College Attended Good Standing Probation Suspended Dismissed Are you willing to submit to a background check and drug screen? * Required Yes No Do you have access to a reliable PC and internet connection? * Required Yes No *Note that several classes have technical requirements; they will be posted on the syllabus. Apple, Mac, or Microsoft Edge notebooks are not compatible with Electronic Health Record applications used in the HIM program. Please review technical requirements with your instructor.