PROGRAM APPLICATION

Health Information Technology/Coding Certificate programs

Lone Star College - North Harris

*Click here to access the Health Information Technology FERPA form. Please complete and sign the form. No notary services are required. At the end of the application, you will be required to upload an attachment of the signed copy.

**REMINDER: A clear criminal background check is required for admission to the program. You may visit castlebranch.com to initiate the background chceck process, use package code HM44BG. The average processing time is 7 - 10 business days.

PERSONAL INFORMATION

Title: *

First Name *

Last Name *

Suffix

Lone Star College ID number * 🛈

Street Address *

Apartment/Suite Number

City *

State *

Zip Code *

Contact Phone Number *

Email Address *

Highest Level of Education completed? *

High School Name: *

Previously attended College/University #1: * 🛈

Previously attended College/University #2: * 🛈

Previous Work Experience: *

Do you have any certificates related to the Health Information Technology/Medical Coding field? *

PROGRAM RELATED INFORMATION

Preferred Program: * 🛈

Preferred attendance: *

Please provide a personal statement as to why you are interested in becoming a Health Information Management professional or Professional Coder. *

Please submit completed Health Information Technology FERPA form here. *

Acknowledgment and Signature

By checking this box, I am acknowledging that I am interested in the program and have read the information above. I have completed the background check and provided the required documentation during the appropriate time frame. (Please visit https://www.lonestar.edu/health-info-tech-requirements.htm for a complete list of requirements) *

Yes, I verify that information provided is accurate, to the best of my knowledge.

clear

Date: * +