Personal Information  

First Name:

Middle Name:
Last Name: (required)
E-mail Address: (required)
Home Phone Number: (required)
Cell Phone Number:
Address: (required)
City: (required)
State: (required)
Zip: (required)
Educational Background
High School:
Year Graduated: (required)
College: Hours Completed:
Degree: Year Graduated:
Other Education (describe):

Work Experience:
Describe your work experience, particularly any experience you might have in healthcare:

Program Schedule selection:
Medical Office Procedures Certificate Program
Medical Coding Certificate Program
Medical Coding AAS Degree Program
Medical Transcription Certificate Program
Medical Transcription AAS Degree Program

I verify that all of the information provided is, to the best of my knowledge, accurate. I also acknowledge that a criminal record check will be required in the future if I complete my field work experience in a hospital setting at a JCAHO facility. I also acknowledge that I will complete a program final examination as written by the Cowley College Medical Office Division Advisory Committee.

*Incomplete applications will not be considered.

Official transcripts for high schools and colleges must also be sent to our registrar.