Ophthalmic Medical Assisting Application for Admission
Applications are validated by completing an information session September 25, 2018 to December 4, 2018.

Deadline for submission of the Health Science application is March 15, 2019.

First Name *
Last Name *
Student ID Number *
Street Address *
City *
State *
Zip Code *
Phone Number *
Personal Email Address *
MYEDGE Email Address
The MYEDGE email account is created upon application to the school. This is the address all faculty and staff will use to contact you once your application to the college has been submitted. Example: First Initial, Last Name, Date of Birth (jdoe0612@myedge.cc)
Have you completed an admissions application to Edgecombe Community College? *
Educational Experience *
High school or GED completion date *
College/Training Previously Attended *
Include all (1) colleges attended, (2) degrees/diplomas/certificates awarded, and (3) years attended.
Official Transcripts *
Do you have work experience related to the medical field? *
If you answered yes to the question above, list (1) Employer (2) Modality (3) Date/s you worked
Do you have any active certifications (excluding CPR)? *
If you answered yes to the question above, list (1) Certifying agency (2) Certificate earned (3) Date earned
Edgecombe Community College serves the public without regard to race, creed, color, religion, national origin, or sex.
When did you attend an information session? *
ECC Health Sciences Admission Policies and Requirements *
*All required fields must be completed for successful submission of this application.
Never submit passwords through Google Forms.
This form was created inside of Edgecombe Community College. - Terms of Service