Medical Assistant Program Application

Student ID# (Please include leading zeros and be a 7 numeric digit.)*

First Name*

Middle Name

Last Name*

Address*

City*

State*
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip*

Lake Land College Email:

(Note: all further correspondence will be via Laker email)

Select program to which you are applying and fill in the year you want to begin:

Medical Assistant - Certificate
Fall semester of: 2025 2026 2027 (year)*

Check if you are currently working in the healthcare field.
**Students who are currently working in the healthcare field must submit a completed Employment Verification form and proof of current certification within 7 days of application. Submit via email to hcox@lakelandcollege.edu or via fax to 217-234-5019.

Upon submission, test scores, college credits or proof of employment status/certification will be reviewed to determine eligibility into the medical assistant program. You will be notified of your next step by Laker email.

Review the appropriate Medical Assistant Program Application Checklist.
The checklist contains information needed to ensure your application is complete.

INITIAL: I have reviewed the information in the Application Checklist.*

Students applying to the medical assistant programs at Lake Land College must be able to meet the technical requirements of the program and not pose a risk to the well-being of clients, other students, staff or themselves. Students applying to the program will need, at a minimum, to be capable of performing all Functional Abilities required of the medical assistant. The student will need to maintain and demonstrate these abilities through the duration of the program.

INITIAL: I have reviewed the list of Functional Abilities and understand that I need to be able to be perform these functions to complete the medical assistant program.* List of Functional Abilities can be found on the Medical Assistant Program Checklist.