HEALTH INFORMATION MANAGEMENT PROGRAM APPLICATION

Full Name*

Prefix

First

Last

Suffix

Student ID (SISID)*

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Daytime Phone*

Other Phone

Date of Birth

Email*

I have healthcare experience.*

I am a high school graduate or have completed a GED.*

I have been to counseling and taken the Math and English placement tests.*

I have passed MTE 5 or higher, or taken a college math course.*

I have passed Biology 141 with a C or higher.*

Other courses I am currently enrolled in or have taken: (check all that apply)*

My transcripts:*

Do you wish to attend HIM classes full-time or part-time?*

Have you attended an HIM open house in the last year?*

Please briefly tell us about your interest in TCC's Health Information Management program.

Type the characters from the image below.