Information For

Healthcare Information Technology Certificate Program Application

If there are changes to any of the information contained on this application after submission, it is your responsibility to notify Extended Learning at el@csusm.edu.

This program is not currently eligible to accept F-1 visa students.

DO NOT SUBMIT UNTIL YOU COMPLETE THE APPLICATION

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Yes
No


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College/University where degree conferred. Include institution where algebra-equivalent course completed. Unoffical transcripts may be sent to program coordinator for initial review. However, official transcripts must be received prior to start of the program. Applications are not complete and will not be reviewed until transcripts are received.

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PLEASE NOTE: This program is not eligible to accept F-1 visa students

If yes, please list dates of service
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Bachelor's degree
Completion of college algebra or equivalent

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Full Name and Date
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