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									                     Lone Star College-North Harris
                            MEDICAL ASSISTING PROGRAM 2011
                                            Pre-Application Checklist
Program Application Deadlines (First priority given to students who submit applications on or before July 29):
   LSC-North Harris Main Campus- Full-time, Day Program: July 29, 2011 by 3:30pm.

Day Program Start Date: August 29, 2011. Students will be notified of their status by August 12, 2011.

Dear Prospective Student,
Submit the checklist items below, and all supporting documents along with your application, to Lorraine
Schoenbeck, Program Director, by mail to the Health Professions Building (17200 Red Oak Drive, Suite 200 E,
Houston TX 77091) or to Linda K. Genco, WNSP 155 at the North Harris campus or via FAX (281-765-7767). You
cannot apply or register on-line.

Student’s Name: ______________________________________ LSCS student ID#: ____________________

Please check that you have completed each requirement on the checklist. The following criteria must be met in order to
be eligible to apply to the program:

1. ___          I have completed an application for one of the Lone Star Colleges. Student ID number: _____________.
                If you have not taken classes at a Lone Star College System campus within the last year, you must
                update your application at You will need to submit official copies of all
                college transcripts to the admissions office at Lone Star College-North Harris for the purpose of
                evaluation. If you have previously submitted transcripts to a Lone Star College System campus, please
                verify with the admissions department that your transcripts have been received AND evaluated. You will
                need to change your major to C1.MED1 for Medical Assisting.

2. ____         I have attached copies of my Lone Star College System advising profile and program evaluation via
                the MyLoneStar system on the college’s website. Please submit all transcripts and make sure they have
                been processed by the admissions department before printing these documents. These reports will
                indicate your THEA/SSI status and list the classes completed at Lone Star College System and
                transferred in from other colleges. If you have previously enrolled at Lone Star College System, these
                reports are also available from any Lone Star College System campus in the admissions/enrollment
                services department.

3. ____         I have completed an assessment test (THEA, Compass, ASSET, or equivalent) with passing
                scores on the reading and writing sections; or completed the developmental sequence in reading (ENGL
                0305 or ENGL 0316) AND the writing (ENGL 0307 and ENGL 0326) and am eligible to enter ENGL 1301.
                These test scores also show that I have tested above MATH 0306 and into MATH 0308 or higher.

4. ____         I have completed the Medical Assisting pre-entrance test (PSB Test) and attached a copy of the scores to
                my application. The test will be available on April 19, 2011 through August 5, 2011 in the LSC-North
                Harris Assessment Center located in the new Student Services Building on the North Harris campus for
                $20. Sign-up instructions will be on the Authorization to Test Form, which will be available on the website
                on April 1.

5. ____         I have attended a mandatory Medical Assisting Information Session as posted on the Lone Star College-
                North Harris Medical Assisting website.

6. ____         I have submitted the required background check.

7. ___          I have completed and attached a completed Medical Assisting program application by the posted
                deadline. (The Physical Exam form will not be due until you are admitted into the Medical Assisting

    Student Signature __________________________                 Date ____________________
                              Lone Star College-North Harris

                                                                 Medical Assisting
                                                           Application for Admission
                                                   Follow instructions on application checklist.
Name in full (please print):
                                            Last                                        First                              Middle

Any other name(s) used while attending school:

Home Address:
                         Number & Street               Apt. #                           City                    State             Zip

Home Phone: (            )                             Alt. Phone: (          )                              Student ID

Email (required): _____________________________________________________________
(you will be notified of your admission status by August 12, 2011.)

List High School graduation or GED:

Name of School                                                     City & State                                  Date of Graduation/G.E.D.

List all college, university, or vocation schools attended:
Name of Institution                                                City & State                                  Date of Graduation/G.E.D.

                             An official copy of your transcript(s) from all schools attended is required for admission and
                                                    must be on file with Lone Star College System.

List any licenses or certificates held in health care occupations (please attach a copy of licenses/certificates)

List volunteer/work experience in a healthcare setting:
Facility                     Supervisor                   Phone (area code/number)              Period of time (mo/yr-mo/yr)        # of total hrs.

I hereby certify that the information contained in this application is true and correct to the best of my knowledge. I
understand that any misrepresentation or falsification of information is cause for denial of admission or immediate dismissal
from the program.

Date:                                          Signature:

Lone Star College System (LSCS )is committed to the principle of equal opportunity in education and employment.. LSCS does not discriminate against individuals on
the basis of race, color, religion, gender, disability, age, veteran status, national origin, or ethnicity in the administration of its educational policies, admissions
policies, employment policies, scholarship and loan programs, and other district or college administered programs and activities.
                                                                                                                                                    Revised: 01/11/2011

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