Medical Coder/Biller Application

Thank you for your interest in the Health Information Technology Program. Please complete all information.

Date +

Applying for Semester/ Year *

Contact Information

First Name *

Last Name *

Former name(s) (maiden) that may identify transcripts

SJC Student ID Number *

Phone *

Mailing Address *

Address Line 2

City *

State *

Zip Code *

SJC Live Student Email Address *

SJC Student email ends in @my.sanjuancollege.edu. This email is the official form of communication between San Juan College facilitators and students and thus a required field.

Personal Email Address

Education

Check highest level completed

GED

High School Diploma

Associate Degree

Other Other

Please list the name and the location of each college previously attended

Name

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City

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State

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Dates Attended

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Official transcripts must be requested from colleges and universities previously attended to transfer credits. Have transcripts sent directly to the San Juan College Admissions and Records Office. Transcripts will be evaluated by Admissions and Records ONLY UPON FORMAL REQUEST BY THE STUDENT.

Prerequisite Courses:

Prerequisite courses must be completed (or in progress) BEFORE applying to the HIT Program.

Prerequisite Courses: Prerequisite courses must be completed (or in progress) BEFORE applying to the HIT Program.

BIOL 1130 Introductory Anatomy/Physiology Non Maj

BIOL 1130L Introductory Anatomy/Physiology Lab Non Maj

FYEX 1110 First-Year Seminar (can be waived with 24+ previous college credits)

HITP 110 Medical Terminology

General Information

How did you hear about our program? *

Why are you interested in the HIT program? *

Experience:

Briefly describe any previous health information or health related work or volunteer experience. List CCS, CCA or any other professional credentials(s) that you already hold. *

Criminal Background Checks:

Please note CRIMINAL BACKGROUND CHECKS are required by state and federal law.
I understand that as a student in the SJC Health Information Technology Program, I WILL be required to have a criminal background check completed as a mandatory requirement for the Professional Practice Experience (PPE), and results will be provided to the SJC HIT Department. I further acknowledge that there may be a fee for this, which I will be responsible for.

I certify that the information provided in this application is true and complete to the best of my knowledge.

Signature *

clear

San Juan College does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, handicap/ disability, age, or Vietnam era/ disabled veteran status in employment or in the application, admission, participation, access and treatment of persons in instructrional programs and activities.