Mujeres Unidas Avanzando: CMA Application

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This form is for the Clinical Medical Assistant training program at MUA. This form is to determine eligibility. If you are eligible, you will be added to the waiting list for future cycles. When a space is available, you will be contacted by a member of our team for an interview to discuss the training, the schedule, and your goals, so we can ensure that this is the right training for you. We cannot guarantee when a space will be available, as our program is very popular. Thank you for your patience!

Email *

Full Name: *

Email Address: *

Telephone Number: *

Date of Birth: *

YYYY

If you are between the ages of 18-24, you will be asked to provide additional documentation when you begin the training. We have additional coaching supports and resources specifically for this age group that will be available to you. Are you in agreement with this? *

Yes

Does not apply to me

Sex: *

Female

Male

Other:

Preferred Pronouns: *

She/her/hers

He/him/his

They/them/theirs

Other:

Address (# and Street): *

Address (City): *

Address (Zip Code): *

Are you authorized to work in the United States? *

Yes

Other:

Last four digits of your SSN: *

Are you interested in daytime classes or evening classes? (We do not offer both schedules every semester, but we will make a note of your preferences and do our best to accommodate as much as possible.) *

Daytime only

Evening only

No preference/Not sure

Are you fully vaccinated against COVID-19? *

Yes

In process

Other:

Do you have a high school diploma or GED/HiSET? *

Yes

Other:

This class combines in-person and online (Zoom) lessons. Both parts will be required. Are you comfortable with this? *

Yes

Other:

You will need an advanced level of English for this training. Are you comfortable with this? *

Yes

Other:

Are you interested in working as a CMA right when this training ends? *

Yes

Other:

Do you have any experience working in healthcare, in the U.S. or in another country? Please be as specific as possible. *

Why are you interested in completing this training? Explain in detail. *

How did you learn about this training? *

Have you studied at MUA before? If yes, in which class and what year? Please be as specific as possible.

Send me a copy of my responses.

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