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Applicant Information
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Step
1
of 9
Applicant Information
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Edcuational Courses
Which edcuational course are you interested in?
*
Medical Assistant Front Office
Medical Assistant Back Office
Medical Assistant Practicum
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Emergency Contact
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Relationship to applicant
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Phone
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Email
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Demographic Data
Gender
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Ethnicity (check all that apply)
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Is English your first language?
*
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Applicant Educational Experience
Check highest level completed
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Enrolled in high school
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Have you received a high school diploma or its equivalent?
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Still enrolled in high school
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Name of College/University (If applicable)
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Applicant Work Experience
Do you have work experience?
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Employment
List the job, your title, description, hours per week, and dates of employment.
Employment
List the job, your title, description, hours per week, and dates of employment.
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Statement of Career Goals
Statement of Career Goals
*
1-2 paragraphs. Please state your career goals beyond United University of Nursing.
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Criminal History
Have you ever been convicted of a felony?
*
Yes
No
If yes, please include more information
*
Date of the felony, nature of the felony, what court, and the outcome. Please be specific. Include copies of court documents if available. NOTE: This question must be answered for your application to be processed.
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Checklist
Attach a copy of your driver's license, state ID, or high school ID
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Unofficial transcripts from highest level of education
*
Click or drag files to this area to upload.
You can upload up to 2 files.
I acknowledge that I will be required to purchase a background check and drug screen if I am admitted to the MA practicum course.
*
Yes
I acknowledge that I will be required to participate in pre-counseling with UUN Administration if I am admitted to the MA program.
*
Yes
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