Life and Health Sciences Application

life and health sciences
Degrees, Certificates, and Short Term Certificates

*required fields

note: application to Sinclair Community College must be received by Registration & Student Records before this application can be processed.

Date:

*I am a current student. Yes No

*Have you attended Sinclair before? Yes No

*Have you filled out and submitted a Sinclair application? Yes     No
   This Application will not be processed if you have not filled out an application
   to Sinclair.

*Have you taken the placement test at Sinclair? Yes No
*If yes, when? (mm/yyyy)

*Last Name *First Name

M.I. Maiden Name

*Address

* City *State * Zip Code

Home Phone Work Phone

Cell Phone *E-mail

Birth Date (mm/dd/yy)

*Tartan ID
Tartan Card number or last four digits of SSN

*Have you previously attended another college? Yes No
If yes, where:

Check the program you are interested in pursuing.
Degree Programs Select a maximum of 3.
Dental Hygiene Dietetics & Nutritional Management Health Information Management Medical Assistant Technology Mental Health Technology Nursing (Are you an LPN?) Yes No Occupational Therapy Assistant	Physical Education Exercise Science Track Physical Education Physical Education Track Physical Education Sports & Recreation Track Physical Therapist Assistant Radiologic Technology Respiratory Care Surgical Technology

Certificate/Short Term Programs Select only 1.
Activities Programming Chemical Dependency Counseling Clinical Phlebotomy Dietary Management EKG Technician Exercise Specialist Medical Office Coding & Billing Specialist	Medical Office Receptionist Nurse Aide Training Patient Care Assistant Pharmacy Technician Tissue Banking Technologist Expanded Functions Dental Auxiliary (Must be a Certified Dental Assistant or RDH to apply) Other

Human Validation

Please type the letters as you see them in the image above. The letters are case sensitive