Medical Assistant Program Application

This form is not an application to the College. It is part of your application to the program.

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Medical Assistant Program Info


Fall semester of: (year)*


Fall semester of: (year)*

Check if you have a current CNA certification (proof of certification must be turned in to the Allied Health Department by May 1st.)

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.*

Upon submission of this document, your test scores and college credit will be reviewed to determine eligibility into the medical assistant program.
You will be notified of your next step by Laker email.

Electronic Submission of this document is required to begin your medical assistant program application file.



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