EDUCATION - Continuing /
Other
Did you attend an accredited institution of
medicine ,
nursing or
medical assisting ?
Institution name: Location: Year of graduation: Degree Title/Program granted: If you did not graduate, how many semesters did
you complete? How long have you been working as a Medical
Assistant? If not working at present, how long since you
last worked as an MA?
List the last 3 (if applicable) places you
have worked as a medical assistant (facility
name, location, dates of employment)
How long have you been working as a Physician
or Nurse?
If not working at present, how long since you
last worked as a Physician or Nurse?
N/A
List the last 3 (if applicable) places you
have worked as a Physician or Nurse (facility
name, location, dates of employment)
Documentation to be submitted
for review Do you have a copy of your diploma from an
accredited
medical ,
nursing or
medical assisting institution?
Yes No N/A Do you have a copy of your transcripts from an
accredited
medical ,
nursing or
medical assisting institution?
Yes No N/A
If a graduate of a foreign institution, is
your diploma translated?
Yes No N/A
If a graduate of a foreign institution, are
your transcripts translated?
Yes No N/A *Legible copies of these two forms of valid identification are required. Both identifications must bear the applicant's signature (Social Security Card, from the USA Social Security Administration, with your signature AND
*Do you have these two forms of valid ID with your signature ? (social security card with your signature AND Yes No N/A
If there are any discrepancies between your
valid ID and your diploma and transcripts; letter
of recommendation; and/or work history, do you
have legal documentation to substantiate the
discrepancy (birth, marriage, divorce
certificate)?
Yes No N/A If in a language other than English, is your
documentation translated?
Yes No N/A
Do you have an official letter of
recommendation from your physician employer, on
original facility letterhead , stating
dates of employment,
specific clinical and clerical duties
performed and the physician s
determination you are qualified to be a
traditional medical assistant. (This letter must
include the physician s
signature and medical license number, as this is
an official letter of recommendation). Notes
written or typed on plain copy paper
will not be accepted.
The letter must be official .
Yes No N/A
If in a language other than English, is the
letter translated?
Yes No N/A
If you do not have a letter of recommendation
from your physician employer, do you have an
official letter from the Human Resource
Department of a major medical facility, stating
your length of employment and a copy of the
official posted job description for your
position?
Yes No N/A
If in a language other than English, is the
letter and documentation translated?
Yes No N/A
If you do not have the above-mentioned
necessary recommendation documentation, do you
have a copy of your recent official work history
documentation from your country of origin?
Yes No N/A
If in a language other than English, is your
work history documentation translated?
Yes No N/A TRADITIONAL MEDICAL ASSISTING DUTIES
PERFORMED . These are the duties you
PERFORM on a daily basis. DO NOT include
œknowledge of
aspects of medical assisting. Doing so is a
disservice to your place of employment; to the
physicians, nurses and support staff with whom
you work; to the patients you attend; to the
medical community and, most of all, to
yourself.
LIST ALL
CLERICAL :
LIST ALL
CLINCAL :
Your diploma, transcripts, letter of
recommendation and/or official job description
and/or work history submitted for final review
must accurately correspond with what you have submitted for
pre-qualification review. If your application and
documentation submitted for
final review does not correspond with the
pre-qualification form you submitted for review,
you will be
rejected and you will
forfeit your application fee.
PLEASE READ THE FOLLOWING FOR ADDITIONAL INFORMATION REGARDING THE ARMA
APPLICATION PROCESS
All forms are reviewed in the order they are received. Review of your
pre-qualification form may take 2-3 weeks. DO NOT call or email to question the progress
of your pre-qualification review. This action will just delay your review process.
After review of your pre-qualification form, ARMA will contact you with
confirmation of eligibility or your ineligibility to apply.eligible to apply , ARMA will send you an original application. ARMA
will also send you a confirmation notice listing the stated information you entered on
your pre-qualification form. When you submit your signed and dated application with
all required documentation and $60.00 application fee (money order or credit card)
for final review , also include your signed and dated confirmation
notice.
If you are ineligible to apply , ARMA will contact you indicating the necessary
documentation needed to comply with the pre-qualification requirements. All ineligibility
information is entered into a review database for cross-reference purposes. When
you obtain the necessary documentation, complete the pre-qualification form again. ARMA
will review your updated pre-qualification form for eligibility to apply.
If you have falsely or inaccurately answered any of the pre-qualification questions
and you submit an inaccurate or incomplete application for final review , you will
forfeit your application fee. If you have neglected to include all required
documentation for final review , you will forfeit your application fee. You
will receive a rejection notice stating the reason(s) for rejection. All
rejected information will be entered into a reject database for cross-reference
purposes. Your rejected application will be held for 2 months from your rejection
date. If ARMA has not received the required documentation listed on your rejection
notice, the signed and dated rejection notice and the additional $30.00
re-application fee within the 2 months , your application and all contents will
be destroyed.
If you neglected to sign and date your application submitted for final review ,
you will forfeit your application fee. Your rejection notice will be sent
to you with a signature sheet. All rejected information will be entered into a reject
database for cross-reference purposes. Your documentation will be held for 2
months from rejection date. If ARMA has not received your signed and dated signature
sheet, rejection notice and the additional $30.00 re-application fee within the
2 months , your documentation will be destroyed.
APPLICATION FEES ARE NON-REFUNDABLE
All policies, procedures and criteria are
subject to change and may occur without
notice.
