MEDICAL OFFICE TECHNOLOGY PROGRAM
Application for Admission

PLEASE NOTE: You must be accepted to Arapahoe Community College before applying to this program. If you are not an ACC student, complete the online admission application. If you are an ACC student, check the box.


Certificate(s) for which you are applying

MEDICAL ADMINISTRATIVE CERTIFICATE (Major = MOTA)

MEDICAL BILLING AND REIMBURSEMENT CERTIFICATE (Major = BLGR)

MEDICAL ASSISTANT CERTIFICATE (Major = MEDA)

Name:
First

M.I.

Last
Arapahoe Community College Student ID#    (Social Security numbers are not accepted)
Address:
Street
 
City

State

Zip Code
Phone:
Home

Business or Cell
 
Student Assigned Email Address:  
Personal Email Address:  
List courses you will transfer to ACC:
Semester in which you plan on starting the MOT program:  

Applicant Check List:   (Check box to indicate document is uploaded or item is completed.)

College Placement Test scores
(PDF, JPG, GIF or PNG - file size limited to 10MB)

List College Placement Test scores (CCPT scores, if applicable):
Reading
Essay
Pre-Algebra Diagnostic Math test.  Name of test taken – OR Pass MAT 050 with “C” or better

Do you already have a college degree? (2 year or 4 year or higher) IF YES, upload a copy of the degree award OR a copy of the unofficial transcript. To transfer general education courses a student must submit official transcripts to the Admissions and Records office.
(PDF, JPG, GIF or PNG - file size limited to 10MB)
Read “MOT STUDENT GUIDE” document from the ACC Website and Complete and SIGN the LAST TWO PAGES to be uploaded with your application
(PDF, JPG, GIF or PNG - file size limited to 10MB)
Please upload proof of your high school diploma or GED.
(PDF, JPG, GIF or PNG - file size limited to 10MB)

Please discuss the following topics. Use only the space available to respond.

1. What are your reasons for pursuing a career in Medical Office Technology?

2. What experiences have influenced your decision?

3. What are your professional/academic goals?


To the best of my belief, the information I have given on this form is correct and can be verified.
By entering my full legal name, I am creating an electronic signature as binding as my handwritten signature.
Signature Date