Health Information Technology Program Application

First Name:

Last Name:

Blinn ID Number:

Email:

Phone Number:

Street Address:

City:

State:

Zip Code:

Anticipated Starting Semester
Fall
Spring
Summer

Health Information Technology (Online)
Certificate plan
2-year AAS plan
3-year AAS plan
4-year AAS plan

Medical Billing and Coding Specialist Certificate (Online)
1-year plan
2-year plan
3-year plan
Feeds directly into HIT AAS

List all educational institutions that you have attended: Name of college, major, date of attendance

It is your responsibility to provide Blinn Admissions with an official transcript. You must also be a high school graduate or have obtained a GED to be admitted to any Allied Health Program.

Please remove any special characters, email addresses, and URLs.

Current/Most Recent Employment: Name of employer, job title, length of employment

Please remove any special characters, email addresses, and URLs.

Have you ever been convicted of a misdemeanor or felony? If yes, please explain

Please remove any special characters, email addresses, and URLs.

Acknowledge Notice: I certify that the information, provided in this application, is correct and complete. I understand that omission or falsification of information is grounds for exclusion and dismissal. I agree to meet all entrance requirements and to conform and abide by the letter and spirit of the rules, regulations, and procedures of Blinn College District and this program. Even though the HIT programs are open enrollment, the application is necessary for sending out the program handbook, class advisement, class registration, and clinical preparation.

I have read, understood, and agree to Acknowledge Notice above.

The Blinn College District is accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) to award associate degrees. The Blinn College District also may offer credentials such as certificates and diplomas at approved degree levels. Questions about the accreditation of the Blinn College District may be directed in writing to the Southern Association of Colleges and Schools Commission on Colleges at 1866 Southern Lane, Decatur, GA 30033-4097, by calling (404) 679-4500, or by using information available on SACSCOC's website (www.sacscoc.org).

The Blinn College District does not discriminate on the basis of race, color, national origin, sex, or disability. For information regarding Title IX, ADA, Section 504, and other anti-discrimination coordinators, see the Student Title IX page.

HIT Program Application

Health Information Technology Program Application

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