SUNY Downstate Medical Billing and Coding Online Program Application

Which program are you applying for?
First Name
Your answer
Last Name
Your answer
Address (Street Address, City, State, Zip)
Your answer
Email
Your answer
Phone Number
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Gender
Select one of the following:
High School school attended - Name, State/Country if not USA, Date of attendance, graduation date (month/year)
Your answer
College/University attended - Name, State/Country if not USA, Date of attendance, graduation date (month/year)
Your answer
College/University attended - Name, State country if not USA, Date of attendance, graduation date (month/year)
Your answer
Degree Earned, if applicable
Your answer
Current Employer- Name, City, State
Your answer
Position, Years employed
Your answer
What is your motivation for choosing this program? What do you hope to gain from this curriculum?
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How has your prior academic work or employment prepared you to pursue this profession?
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How would you handle a scheduling challenge between work, home and your school responsibilities?
Your answer
How would you describe yourself; strengths/weaknesses?
Your answer
Financial
Tuition for the entire certificate program is $3,500. For payment arrangements please contact the Medical Billing and Coding Department at 718-270-7604. Fees do not include books. Cancellation fee is $50.
Fees
To Pay by Credit Card or E-Check
1) http://sls.downstate.edu/bursar/emarket.html
2) Choose "Continuing Medical Education" .
To Pay by Mail
Forward check to:
College of Health Related Professions Dean's Office
450 Clarkson Avenue, MSC 94
Brooklyn, NY 11203
I hereby certify that all the information given in this application is accurate and complete. I understand that all the information contained in this application will be treated confidentially and will be used for institutional purposes only. I realize that failure to provide complete and accurate information may affect my admission. I understand that my application will not be considered until all necessary documents are received by the Office of Admissions.
Signature
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Date
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