Certified Clinical Medical Assistant (CCMA)- Interest Form

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CURRENTLY NOT ENROLLING IN CLASSES. IF YOU FILL OUT THIS FORM, WE WILL CONTACT YOU WHEN WE SCHEDULE OUR NEXT CLASS. THE NEXT CLASS SHOULD START SOMETIME LATE JULY OR EARLY AUGUST.

Please complete this form if you are interested in an upcoming state-funded Certified Clinical Medical Assistant (CCMA) class.

This non-credit program prepares medical assistant students for the NHA exam (included) and to perform patient clinical skills in the medical office setting. Students will learn how to perform clinical procedures including administering medications, assisting with minor surgery, performing an electrocardiogram, obtaining laboratory specimens for testing, educating patients, and maintaining clinical equipment in an ambulatory care setting. Medical assistants perform routine clinical tasks to keep the offices of physicians, podiatrists, chiropractors, and optometrists running smoothly.

Email *

First Name *

Last Name *

What City do you live in?

If you do not live in Indianapolis, IN or a surrounding city, please stop and do not submit this application, you are not eligible for this class at this time.

Phone number *

Date of Birth *

YYYY

The CCMA providers we use require that students have Internet service and a working device (computer/laptop/iPad) with a camera and microphone. *

Yes, I have a working device and Internet that is not my smart phone.

No, I do not have access to a working device and/or internet.

Select ALL that apply...

Please Note: If you can not check off ALL of the class requirements, please STOP and do not submit this form. You may try again once you can check off all requirements.

I have a High School Diploma or equivalent, from the US or abroad-translated (required).

I am a US citizen Or I have the documentation to work legally in the United States

I am 18 years old +

I have reliable transportation to get to class on time

Other:

Required

We offer CCMA classes in partnership with various community partners. Classes are generally scheduled during the fall and spring semesters depending on the availability of instructors, classroom space, and funding.

Everyone who submits this form and meets the requirements of this class will be contacted every time we have new CCMA classes. (for up to 6 mo)

I understand that with this one submission I will be contacted about new CCMA classes for up to 6 months from today.

Required

A copy of your responses will be emailed to the address you provided.

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