Application for Admission to the Medical Administrative Assistant Certificate Training Program

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Application Purpose and Guidelines:
The purpose of this application is to document the skill set of the Medical Office Specialist Certificate Training candidate. This enables the Selection Committee to properly assess each candidate’s skills, abilities, background and motivation to succeed. Our goal is to select candidates who will be successful in the program and become competitive for employment.

Submit the Completed application and supporting documents to:

Great Bay Community College
Business & Training Center
320 Corporate Drive
Portsmouth, NH 03801

Required documentation:
1. Completed Application
2. Resume
3. Transcript of completion of highest degree earned or proof of GED or HiSet
The Selection Committee will review the completed application and supporting documentation and interview the candidates. Interviews will be conducted when all required documentation has been received.

The selection process will consider:
- Candidates who are 18 years or older.
- Candidates who have a desire to work in the medical field
- Candidates who will commit to an intense twelve-week/240-hour program of instruction.
Application Information: MOS
Please indicate the class for which you are applying (start date):
Applicant Name*
First Middle Last
Address*
Street Address City State ZIP Code
Preferred Email*
Primary Phone*
Secondary Phone
- Cell
- Home
- Work
- Cell
- Home
- Work
Resume*
Reference Contact Information
First Last
Phone
Email
Relationship
In a medical emergency, please contact:
Emergency Contact Information*
First Last
Phone*
Signature of Applicant*
Date*
Date Format: MM slash DD slash YYYY
Notice of Non-Discrimination
Great Bay Community College does not discriminate in the administration of it admissions and educational programs, activities, or employment practices on the basis of race, color, religion, national origin, age, sex, disability, genetic information veteran status, sexual orientation, political affiliation or marital status. This statement is a reflection of the mission of the Community College System and Great Bay Community College and refers to, but is not limited to, the provisions of the following laws: Title VI and Title VII of the Civil Rights Act of 1964, as amended, the ~ The Age Discrimination Act of 1967 (ADEA) ~ Title IX of the Education Amendment of 1972 ~ Section 504 of the Rehabilitation Act of 1073 ~ The Americans with Disabilities Act of 1990 (ADA) ~ Section 402 of the Vietnam Era Veterans’ Readjustment Assistance Act of 1074 ~ Genetic Information Nondiscrimination Act of 2008.

Years serving NH residents

Application Information: MOS

In a medical emergency, please contact: