California State University San Marcos Extended Learning

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.

DO NOT SUBMIT UNTIL YOU COMPLETE THE APPLICATION

*Last Name

*First Name

*Middle Initial

If Applicable, Please list any other name that may appear in your academic records.

*Date of Birth

*Street Address

*City

*State

*Zip

*Employer Name

Employer Address

*Phone Number(s)

*Email

*Are you currently working or have you worked previously in either the Healthcare or IT industry?

Yes

*If yes, please indicate how many years in the industry?

*What is your current occupation?

Please list all colleges or universities you have attended or are currently attending. Official transcripts are required from each institution attended.

*1.

*Highest Level of Education

*Please list date received and major

CSUSM Student?

International student?

If yes, please list your Visa status

US Veteran?

If yes, please list dates of service

*Personal statement: in at least 300 words, please describe your career aspiration in healthcare information technology

*Please indicate which admissions requirements you have met

Bachelor's degree

Completion of college algebra or equivalent

Please submit resume within 48 hours of program application. You may also email your unofficial transcripts to expedite the review of your application. Upon acceptance, official transcripts will be required.

*Semester applying for

*How did you hear about our program?

*I certify that all information provided in connection with this application is true, correct, and complete.

Full Name and Date

*First three letters in last name and last four digits of your SSN; all UPPERCASE and no spaces

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Submit

Your application to the HIT program at Cal State San Marcos, Extended Learning has been submitted!!
You next step is to email your resume to bramos@csusm.edu with "HIT" in the subject line and order your official transcripts.
You may submit your unofficial transcripts to the email above to expedite the review of your application (we anticipate the cohort to fill). You can also deliver in person to the Extended Learning Student Services Office located in FCB 5-107, or mail. 
Please mail official transcripts to:
California State University San Marcos
Extended Learning
Attn: Student Services, HIT Program
333 S. Twin Oaks Valley Rd.
San Marcos, CA 92096
Complete applications (those including resume and transcripts) will be reviewed in the order received and acceptance letters sent to successful candidates shortly after. Please contact Bryana Ramos, Program Coordinator for HIT with any questions regarding your application: bramos@csusm.edu
Thanks for your interest in the Healthcare IT Program!
Sincerely,
CSUSM Extended Learning, Business & Workforce Team in partnership with College of Business Administration