MEDICAL ASSISTING PROGRAM APPLICATION PACKET

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MEDICAL ASSISTING PROGRAM

APPLICATION PACKET

PROGRAM DESCRIPTION

The Medical Assisting (MA) program is accredited by the Commission on Accreditation of Allied Health Education

Program (CAAHEP) and is designed to prepare students for employment in various medical settings, such as

a physician’s ofce, clinics, and certain hospital settings. This program will prepare the student to function in a

medical ofce or clinical environment as a medical receptionist, administrative assistant, insurance coder/biller,

phlebotomist, EKG Technician, and as a back ofce clinical assistant/patient educator.

PROGRAM OFFERINGS

Fall Program: 7/31/23 - 2/26/24

Spring Program: 01/08/24 - 07/25/24

PROGRAM LENGTH

The program consists of 765 clock hours.

PROGRAM HOURS

Fall and Spring Programs:

Full-time Days Monday – Thursday 8:00 a.m. – 4:00 p.m.

PROGRAM LOCATION

Lively Technical College (LTC)

Health Education Department, Building 15

500 North Appleyard Drive

Tallahassee, FL 32304

(850) 487-7449

The Leon County School District does not discriminate against any person on the basis of sex (including transgender status, gender

nonconforming, and gender identity), marital status, sexual orientation, race, religion, ethnicity, national origin, age, color, pregnancy,

disability, military status, or genetic information.

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HEALTH EDUCATION APPLICATION COVER SHEET/CHECKLIST

Name: _____________________________________________________________

Phone: _____________________ Email: ___________________________________

Program: _________________________  Day  Night Program Date: ____________

STEP 1. REGISTER FOR LIVELY TECHNICAL COLLEGE

 COMPLETE THE LTC STUDENT ONLINE APPLICATION

Apply at www.livelytech.com

 MEET WITH STUDENT SERVICES ADVISOR

Must bring:

• Two proofs of Florida Residency

 • OfcialtranscriptsforHighSchool/College/GED

(ForcopyofGEDgotowww.myged.com)

 SKILLS ASSESSMENT TEST OFFICIAL RESULTS (if needed)

 MEET WITH FINANCIAL AID

Financial Aid is available based on eligibility.

 REGISTRATION

OnceyoureceiveyourHealthEducationacceptanceemail,gotoRegistrationto

 nalizeyourpaymentandschedule.

STEP 2. COMPLETE THE PROGRAM APPLICATION PACKET

 HEALTH EDUCATION STUDENT INFORMATION SHEET

 THREE CURRENT REFERENCE LETTERS:

 Tw o professionalreferences(recentemployers,formerteachers,counselors,etc.)

 One personal reference (may not be family member)

 STUDENT HEALTH ASSESSMENT FORM

(Includingimmunizationrecords)

 WRITING SAMPLE

 RECEIPT OF PAYMENT FOR A LEVEL 2 CRIMINAL

BACKGROUND TO LEON COUNTY SCHOOLS

 VACCINATION ACKNOWLEDGMENT

 BASIC LIFE SUPPORT CERTIFICATION (OPTIONAL)

LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.

OFFICEUSEONLY:

 BACKGROUNDRESULTS APPROVE/ACCEPTANCELETTER  ORIENTATION

 Completed required enrollment process to LTC with Student Services. Advisor Initials: _____

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GENERAL REQUIREMENTS

Applicants seeking admission to the MA Program

must:

• Be at least 18 years of age at projected time of

program completion.

• Have a high school diploma or equivalent.

• Pass random drug screenings throughout the

program. Students with positive drug screen

results will be withdrawn from the program.

To apply for acceptance into the MA Program

students must:

• STEP 1 - COMPLETE THE LTC STUDENT

ONLINE APPLICATION. (This application is

required for all LTC students) This application can

be completed at: www.livelytech.com

• STEP 2 - MEET WITH STUDENT

SERVICES ADVISOR- Student Services will

review your online enrollment information. You

will need to provide:

• Two proofs of Florida Residency

• Ofcial Transcripts for High School and

College (if applicable). For copy of your GED

transcript go to www.myged.com

• Academic Skills Test Ofcial Results or

exemption (see below for more information).

• STEP 3 - MEET WITH FINANCIAL AID

– Meet with Financial Aid. They will check for all

needed nancial aid documents (ISIR, verication

letter, etc.) Bring proof of any additional grants,

scholarships, or waivers in order to receive your

deferment. (If you are self-pay, you may skip this

step.). Federal Pell Grant information is at www.

studentaid.gov. School code: 013997

COMPLETE THE MA

APPLICATION PACKET

The MA Application Packet must include:

• Health Education Student Information

Sheet. A printed copy must be submitted with

the application packet.

• Writing Sample

• Three current reference letters:

• Two professional references (recent

employers, former teachers, counselors, etc.)

• One personal reference (may not be family

member)

• Student Health Assessment Form signed

by a healthcare provider OR provide a copy

of your immunization record. Submit with

the application packet. A physical is not required.

• Receipt of payment for a Level 2 criminal

background to Leon County Schools. This

must be completed prior to submitting the

application, at the student’s expense*. In order to

participate in the mandatory clinical practicum, as

well as to obtain licensure, students must have a

clear background.

• Vaccination Acknowledgment

*No refunds will be issued.

LATE OR INCOMPLETE APPLICATIONS

WILL NOT BE ACCEPTED.

TESTING INFORMATION –

REQUIRED TESTS & SCORE

Academic Skills Test (Academic Skills)

State Board Rule 6A-10.040, FAC states the following:

“Students who are enrolled in a postsecondary

vocational certicate program shall complete a basic

skills examination.”

LTC admission policies require that all students that

enroll in Workforce Education Certicate Programs

of 450 hours or more must take the Academic Skills

assessment test or provide proof of acceptable forms

of exemption from testing.

You may be exempt from the Academic Skills test if

you:

• Possess a college degree at the associate in

applied science level or higher.

• Demonstrate readiness for public postsecondary

education pursuant to F.S. 1008.30 (See

acceptable exemptions list in Student Services)

• Earned a standard Florida public high school

diploma (Student entered 9th grade in the 2003-

5

2004 school year or any year thereafter) or

earned a GED in 2014 or any year thereafter.

• Student serves as an active duty member of any

branch of the United States Armed Services

• Passed a state or national industry certication

or licensure examination identied in State Board

of Education rules and aligned to the career

education program, which they enroll.

• Proof of exemption status is required. Please see

an advisor for further details in Student Services.

You must be in the Testing area by 9:00 am to

start the test, Monday – Thursday by appointment

only. For more information, please contact The Testing

Center: 850-487-7410

The academic skills test passing score for the MA

Program is a 10 in Reading, Language and Math. These

scores are valid for two (2) years.

If you do not meet your exit scores, you will need

to enroll in AAAE at a cost of $30 per semester.

The AAAE instructor evaluates your test scores

and an individualized learning plan will be designed

based on your Academic Skills results. Students work

individually, at their own pace, and seek the assistance

of an instructor when needed.

There is a $25.00 fee for this exam. Applicants must

go to the Registration window in Building 8 to pay

for the exam then report to the Testing Center.

For more information, please contact The Testing

Center: 850-487-7410

Regular Hours of Operation: Monday-Friday, 8:00 am-

4:00 pm

HEALTH REQUIREMENTS

Applicants are required to complete a Student

Health Assessment Record by a Healthcare

Provider (not more than 6 months old). If, after

acceptance, a student’s health status changes, further

documentation may be required stating the student is

physically able to continue the program. As stated on

the Student Health Assessment Form, applicants are

required to provide proof of the following current

immunizations:

• Tetanus, within the past 10 years (Td or Tdap)

• MMR x2 (given on or after the applicant’s rst

birthday). Ofcial documentation of immunity is

also acceptable.

• Hepatitis B series.

• Varivax x2 - Ofcial documentation of immunity

is also acceptable.

• PPD/Tuberculin skin test within past 12 months.

PPD/Tuberculin skin testing is valid for one (1)

year from date of administration. Students will be

required to maintain current PPD/Tuberculin skin

testing throughout the duration of the program.

Students who test positive for tuberculosis must

show proof of a negative chest x-ray taken within

the past ve years to satisfy this requirement.

• Seasonal Flu Vaccine (August-March).

CRIMINAL BACKGROUND

CHECK

All applicants must undergo a Level 2 criminal

background through Leon County Schools in order

to participate in the mandatory clinical practicum, as

well as to obtain licensure, students must have a clear

background. The cost for both is $61.00.

DRUG SCREENING

Drug screening is not required prior to admission

into the program. However, all students must submit

to and pass three random drug screenings after

entering the MA Program and prior to having access

to the clinical health care facilities utilized in the

Program. This is a Joint Commission on Accreditation

of Healthcare Organizations (JCAHO) requirement

demanded of all acute care facilities in Florida.

Students who do not pass a random drug screening

will be withdrawn from the program.

DISABILITY SUPPORT SERVICES

If you have question regarding adult students with

disabilities and accommodations, please contact LTC

Student Services located in Building 9 or at 850-487-

7473.

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FINANCIAL AID

Financial Aid is available for this program based on

eligibility. Qualifying students may be awarded a

Federal Pell Grant based on their current FAFSA

submission provided through the Federal Student Aid,

U.S Department of Education. LTC does not provide

loans. Third party loans and other personal nancial

arrangements are a personal decision of the student

and not handled at LTC. Additionally, LTC accepts

other funding options (Florida Prepaid, CareerSource,

VA, etc.). The Financial Aid Ofce is located in

Building 8, phone number 850-487-7431 or 850-487-

7421 and/or via email at LTCFinAid@leonschools.

net. Please direct all nancial aid questions directly

to their ofce.

ACCEPTANCE INTO PROGRAM

/ REGISTRATION

LTC accepts applicants into all Health Education

programs on a rolling admission basis. As we receive

applications, potential students are scheduled for

an interview with the Health Education Program

Director or their assignee. Once an applicant has

completed the interview, they will be notied of their

admission status. Accepted applicants will be given an

acceptance letter, which will allow them to register

for the program they have applied to. LTC Health

Education programs may be closed prior to the

posted application deadline date once that program

has reached capacity. Questions regarding the

application process should be directed to Ms. Natalie

Grice-Philip, RN, Health Education Program Director

at 850-487-7443.

ORIENTATION

After being accepted into the LTC MA Program,

applicants will be notied about attending a

mandatory orientation. The date(s) and time(s) of this

meeting will be given to all accepted students within

their acceptance letter. For further information,

please contact the Health Education Program

Director at 850-487-7443.

UNIFORMS

Upon acceptance students are expected to wear the

specied program uniform (teal) whenever they are

in the classroom, clinical simulation or clinical facility.

Uniforms may be purchased in the LTC Bookstore

in Building 8. Questions regarding proper attire and

uniforms should be directed to the Health Education

Program Director at 850-487-7443.

LATE AND/OR INCOMPLETE PACKETS WILL NOT BE CONSIDERED.

Lively Health Education

Student Information Sheet

PERSONAL INFORMATION

Date _______________

Last Name _______________________________ First Name ___________________ MI ___________

Address ______________________ City/State _____________________ Zip ______________________

Home # _____________________ Work # __________________ Cell # ________________________

Email Address _________________ Date of Birth _____________

Emergency Contact _____________ Phone# __________________

Health Education Program applying for:

 Central Sterile Processing  Massage Therapy  Medical Assisting  Nursing Assistant

 Patient Care Technician  Phlebotomy  Practical Nursing

EDUCATION

High School _____________________________________ City/State ____________________________

Highest grade completed ______ Year: _____ Choose one:  High School Diploma  GED

Previous Nursing School _____________________________City/State ___________________________

College __________________ Degree Awarded _______________ City/State ______________________

Military ____________________________________________________________________________

Have you attended any previous HED programs whether you completed or not?

 Central Sterile Processing  Massage Therapy  Medical Assisting  Nursing Assistant

 Patient Care Technician  Phlebotomy  Practical Nursing

 LTC  Name of Institution if other than LTC: _________________________________________

Program Attended _____________________________________Date Attended _____________________

Certication Awarded  Yes  No Date the Certicate Awarded ______________________

Proof required at time of application.

EMPLOYMENT RECORD

Present ______________________________________ Title/Position ____________________________

Dates of Employment: From __________ to _________

Previous _____________________________________ Title/Position ____________________________

Dates of Employment: From __________ to _________

Previous _____________________________________ Title/Position ____________________________

Dates of Employment: From __________ to _________

The information on this application is true and factual.

Signature: ____________________________________________Date: __________________________

1. MMR (Need proof of two MMR vaccines or one mumps, two measles, and one rubella.

Any person born before 1/1/57 will need proof of rubella immunization or positive titer.)

Date of MMR #1: Date of MMR #2: _________

OR

Antibody titers:

Mumps titer date: ________________ Results:  Immunity  Not immune

Rubeola titer date: _______________ Results:  Immunity  Not immune

Rubella titer date: ________________ Results:  Immunity  Not immune

If not immune, will require MMR x2.

2. Tetanus (Td or Tdap with the last ten years): Date: ___________________

3. Hepatitis B series:

_________________________________________________________________

Hepatitis B #1 date Hepatitis B #2 date Hepatitis B #3 date

OR

Antibody titer date: _________________ Results:  Immunity  Not immune

4. Varicella:

History of having Chicken Pox is not accepted.

Date of 1st dose: _____________ Date of 2nd Dose __________

OR

Varicella titer date: _______________ Results: ___________(Lab value)

5. PPD (TB Skin Test): __________________ Date taken: ___________________

Results: ______________________ Positive ____ Negative ____

Chest x-ray, if positive PPD: __________________Date: _______ Results: ______

6. COVID-19 Vaccine: Date of Vaccine #1: ______ Date of Vaccine #2: _____ Date of Booster: _____

(Or exemption letter submitted)

7. Seasonal Flu Vaccine: Date of Vaccine: _________Injection Site: ________

(August - March) Lot Number Expiration: _______ Examiner’s Initials: ______

Veried by:

________________________________________________________________________________________

Name of Physician’s Ofce/Health Center Physician’s Signature

________________________________________________________________________________________

Address of Ofce Date

HEALTH EDUCATION

STUDENT HEALTH ASSESSMENT RECORD

THIS FORM MUST BE COMPLETED BY YOUR HEALTH CARE PROVIDER or attach your immunization record.

A physical is not required. Any falsication of this record will result in immediate dismissal from the program (if

accepted).

NAME (please print): ___________________________________________________________________

Last First MI

DATE OF BIRTH: ____ / ____ / ___ Male ____ Female _____

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WRITING SAMPLE

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Why have you chosen to pursue medical assisting as a career?

_______________________________________________________________________

What qualities do you believe you possess that will enable you to perform effectively as a student

and later as a practicing medical assistant?

_______________________________________________________________________

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Because this program is so rigorous, tell us about the support plan you have in place to

successfully complete this program?

_______________________________________________________________________

LEVEL 2

BACKGROUND SCREENING

REQUEST FORM

The following individual needs to obtain a

Level 2 Background Screening, per Florida Statute 1012:

IMPORTANT:

The ORI number for the screening is V37020031

PLEASE PRINT

LAST NAME: _________________________________

FIRST NAME: _________________________________

DATE OF BIRTH: ______________________________

SOCIAL SECURITY NUMBER: ____________________

DRIVER LICENSE NUMBER: _____________________

PHONE: ____________________________________

The above individual will be at Lively Technical College/Externship/

Clinical Site for the following purpose:

__ Student

Entity/Individual from Lively Technical College making this request:

Lively Administration

Please submit print results to:

ATTENTION:

BJ Van Camp, CTE Director

Lively Technical College

500 North Appleyard Drive,

Tallahassee, Florida 32304

Fax: 850.487.7478

Level 2 screening standards

(Fingerprints) return criminal

history results on arrests (including

juvenile) nationwide. Under Florida

Statute 1012, persons with specied

access require level 2 screening.

Offences outlined in Florida State

Statute 435.04 (crimes of moral

turpitude) can be disqualifying

when persons have been found

guilty of or entered a plea of nolo

contendere (no contest).

Instructions:

1. Go to the Fingerprinting Ofce

at the Leon County Schools

District main ofce, located

at 2757 W. Pensacola St.,

Building 1 (to the right of the

main district ofce). The hours

for the Fingerprinting Ofce

are: Monday-Friday, 8:00 am-

5:00 pm - Take this form with

you.

2. Submit payment for screening.

Payment can be via credit card

or money order.

3. Obtain a receipt for the

screening.

Submit the receipt of the

background screening along with

the Health Education program

application.

If your background screening does

not come back “clear,” you will be

notied.

Additional information may be

required.

LEVEL 2 BACKGROUND

SCREENING

INSTRUCTIONS

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Please attach a copy of either your COVID-19 vaccination card

or an appropriate exemption form.

Exemption forms may be found at the following website:

https://www.floridahealth.gov/newsroom/2021/11/20211118-florida-department-health-covid19-

vaccination-exemption-forms.pr.html

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livelytech.com 850.487.7555

500 Appleyard Drive, Tallahassee, Florida 32304