Certified Clinical Medical Assistant Program

Contact Information

First Name

Last Name

Social Security Number

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Mobile Phone Number

Birthdate

School Information

Did you graduate high school or obtain your GED certificate?

High School Diploma

GED Certificate

Transcript / GED Certificate

Upload a copy of your High School Diploma or GED certificate.

Name of College/University attended

Major

Number of Quarters/Semesters completed

Number of credit hours completed

Work Information

Please list your work experience

What is the name of your current employer?

What is your role at your current job?

Additional Information

The cost of the course is $2995.00. Please select your intended payment method:

Self-Pay

Employer Paid (Please provide commitment letter with name and address of where to send invoice)

Grant Funded (CAO, WIET, KY Career Center)

For more information about funding opportunities, contact Zack Stephens at zstephens@shawnee.edu.

Why are you interested in the Certified Clinical Medical Assistant program?

Before clinicals take place, students must also provide the following items:

Physical Exam
Background Check
Proof of Insurance
Immunization Records including Hep B, 2nd MMR, Varicella (vaccine or verification of hx)
2 step TB test results
Flu Vaccine Record
COVID Vaccine Record
Drug Screen