Health Information Management Application Name * Required First Last Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home or Cell Phone * RequiredWork Phone * RequiredVCCS email and/or preferred email: * Required Student ID * Required If currently enrolled at MECC.Have you attended classes before at MECC? * Required Yes No How did you hear about MECC? * RequiredSelect belowFriendMECC Career PathwaysVCCS CatalogInternet SearchOtherIf other, how? Have you submitted MECC Admission application? * Required Yes No Have you submitted high school and/or college transcripts? * Required Yes No Have you completed financial application and FAFSA? * Required Yes No Have you completed and submitted SAP appeal? * Required Yes No Have you completed MTE 1,2, and 3 placement test? * Required Yes No If MTE 1,2, and 3 and/or English placement test is not required, please state reason why: Are you currently working in a health related field? * Required Yes No If so, please provide employer's name and address Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Are you currently enrolled in another program at MECC or elsewhere? * Required Yes No If so, please provide the name of the program and school you are attending:Are you certified in inpatient or outpatient coding currently or in the past? * Required Yes No If currently certified, please state certification: Please list all colleges attended since high schoolLast college attendedStateDegree ReceivedLast year attendedAcademic Standing at Last College Attended Good Standing Probation Suspended Dismissed Do you have a current CPR certification? * Required Yes No Are you willing to submit to a background check and drug screen? * Required Yes No Do you have a home PC? * 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. I understand after submission I will contact Nora Blankenbecler, program director by email at nblankenbecler@mecc.edu to verify my program application has been received. She will be glad to confirm. Confirmation of the receipt of your program application is the responsibility of the student. Yes