Section 1 - Career Information

*Preference does not guarantee schedules will match preference. Course offerings are based on availability.
Section 2 - General Information

Applicant Contact Information

Emergency Contact

Additional Information

SECTION 3 - EMPLOYMENT

SECTION 4 - HIGH SCHOOL INFORMATION

SECTION 5 - PREVIOUS COLLEGE EXPERIENCE

If you have no previous college experience please leave this section blank.

College/University City/State Degree Earned Dates Attended

If you are interested in taking Advanced Placement tests and/or requesting Life Experience Credit for courses in your program, please see the Campus Director or Student Services personnel for more information.

SECTION 6 - SIGNATURE

I hereby apply for admission to American National University . The information that I have submitted in this application is true, and I agree that any inaccuracy or false statement will entitle the college to deny or to rescind admission. If accepted, I agree to abide by the policies of the college.


Education Disclosure

Disclosures

  1. In order to participate in online courses you must first consent to the use of electronic records. If you do not provide such consent, you will not be able to participate in online courses. There is no option to conduct business or receive instruction through the use of paper records in this environment. You will have the opportunity to provide consent or to withhold consent at the bottom of this page.
  2. Note that providing consent for the use of electronic records includes the consent to use an electronic signature to sign this consent page and any documents requiring an electronic signature in the future, and to conduct activities related to online courses, including academic and certain administrative activities using electronic records and signatures.
  3. If you provide consent and begin online courses, then later wish to withdraw consent to use electronic records, you may do so by calling, writing or emailing the Student Services Office. This action will initiate the withdrawal process from any online courses in which you are registered and /or attending. All charges and fees will be assessed and/or adjusted according to the Refund Policy published in the university catalog.
  4. There are certain hardware and software requirements necessary for participation in online courses. If the requirements change, you will be notified. Presently, they are:
    • Desktop or laptop PC with DSL or cable internet, HD webcam, speaker with microphone or headset with microphone.
    • Internet Explorer 7.0 or higher; Firefox 3.0 or higher
    • Popup-blocking disabled; JavaScript enabled; Ajax enabled
    • Adobe Reader and Adobe Flash installed
    • Java Runtime Environment 1.4 or higher
    • Windows XP, Vista or 7 with the most current updates installed; Macintosh OS/X or higher
    • Microsoft Office is required.
    Note: Certain courses may require specific software. Before registering for a course, please contact your instructor or a Student Services Representative for applicable software requirements.
  5. Your participation in online courses with American National University requires the use of certain “shared secrets,” such as a unique login and password for your American National University email account, and a unique login and password to access the Student Portal. Only American National University system administrators have access to this information. The University has strict protocols in place to prevent disclosure to unauthorized parties.
  6. Your University email account will be a primary means of communication with the university administration. If your account is not operational for any reason, contact the Student Services Office for assistance.
  7. You have the right to receive paper copies of items in your American National University electronic student file. These may be requested by contacting the Student Services Office.

Agreement and Consent

I have read and understand the information in the Disclosures section, above. I understand that my participation in online courses will require the use of “shared secrets” such as passcodes, logins and passwords. If I choose to participate in online course(s), I agree that I will not share or disclose these with others, and if I discover that another person has gained access to any of these, I will notify the Student Services Office immediately.

Code of Computing Conduct

Educational Computing Facilities (ECF) are intended to support the academic mission and the administrative functions of the institution. The "institution" includes American National University, University of Fairfax, and any other related entity. This Code of Conduct states the principles regarding the use of ECF. They complement and supplement rather than replace other policies concerning appropriate conduct of staff and students.

The policies controlling acceptable behavior at the institution are implicitly extended to cover the use of the ECF. The impersonal aspect of computers should not be taken as an excuse or reason for people's interactions with others to be anything but well‐mannered, ethical and legal.

For example, if it is unacceptable to display a sexually explicit poster in a public room, it is similarly unacceptable to display such an image on a publicly visible computer screen. Unsolicited, wide distribution of mail or messages should be carried out only if there is a reasonable expectation of interest by the recipients. Even in those cases, care must be taken to ensure that the messages do not overwhelm systems.

Educational Computing Facilities include any computer, computer‐based network, computer peripheral, operating system, software or any combination thereof, owned by the institution or under the custody or control of the institution.

The ECF include stand‐alone workstations and network‐attached systems as well as central servers. This Code also specifically applies to access to ECF via telephone lines, the internet, or other remote access mechanisms.

The following principles apply to all of the institution and institutional staff, institutional students and other users of the Educational Computer Facilities. Users shall:

  1. Be responsible for using these facilities in an effective, ethical and lawful manner.

    This policy states that individual users are responsible for their own actions. For example, if a user transmits illicit materials or stores illegal software, that individual user is responsible such actions and may be held accountable for all results and repercussions of such actions.

    Be aware that wasteful or inefficient use of resources may incur significant expense for the institution or result in a reduction in service to other users.

  2. Use only those facilities for which they have authorization, whether these facilities are at the institution or at any other location accessible through a network.

    Normally, ECF systems require explicit authorization. Authorization based on the provision of false or misleading information is not valid.

  3. Take all reasonable steps to protect the integrity and privacy of the ECF including software and data. In particular, users shall not share with others the access codes, account numbers, passwords or other authorization which have been assigned to them.

    Users are encouraged to report any violations of this policy and any information relating to a flaw in or bypass of computing facility security, to the appropriate Instructor, Campus Director, Department Head or to the Campus Support Information Technology Department. Such security “holes” must not be "tested" without proper authorization. Turning a blind eye to potential violations or system flaws may allow your privacy or access to be jeopardized.

    In this and following sections, "access code" represents the username, account, sign‐on ID, password or whatever system‐dependent mechanisms are used to gain access to particular facilities.

    By allowing your access code to be used by others, you risk compromising the security and integrity of the ECF. As described in several later sections, much software which the institution utilizes requires that all actions be identified and traceable. For these reasons, if you do allow your access code to be used by others, you are responsible for all usage and activities carried out with the code.

    Allowing unauthorized access to ECF indirectly is similarly prohibited (such as allowing access to a private computer at home, where this computer in turn provides access to ECF).

    A computer or terminal logged on and unattended in an accessible location is particularly vulnerable.

    Some system management functions require that all those responsible for such functions share a single access code. Similarly, specific access codes are at times allocated to allow several people performing a common function to receive email. The use of such shared codes must be restricted to the intended purpose. Other usage by the same people should be through single‐user access codes.

  4. Respect the copyrights of the owners of all software, media and data they use.

    Most of the programs made available on the ECF are copyrighted. Copyright law specifically prohibits copying of any software except as explicitly allowed in the usage agreement. Copyright law also provides similar protection for data and text.

    Unless the software explicitly states otherwise, ALL software is copyrighted, even those normally referred to as shareware or freeware. Individual license agreements detail the exact rights and limitations.

    Media files such as music and video files are also subject to copyright protection. Unauthorized downloading of such files, including unauthorized peer to peer sharing of copyrighted material is specifically prohibited.

    Unauthorized use, sharing or distribution of copyrighted material may subject the user to criminal and civil penalties, including fines, incarceration, money damages payable to the copyright owners, and attorneys’ fees. In addition the institution may take disciplinary action against users who violate these prohibitions which may include suspension or termination of employees, and suspension or disenrollment of students.

  5. Respect the policies established by the administrators of external networks such as GAPS, COD, ED Connect, WestLaw, and various virtual library networks when using such networks. They shall also respect the policies established by the administrators of local computing facilities at the institution.

    The use of networks external to the institution must comply with the policies of acceptable use promulgated by the organizations responsible for those networks. This Code of Conduct hereby specifically incorporates these external policies. Adherence to this code ensures compliance with the policies of our associated networks.

  6. Respect the privacy of others. This includes, but is not limited to, respecting the confidentiality of email, files, data and transmissions.

    Records containing information directly related to a student are confidential and protected from public disclosure by the Family Educational Rights & Privacy Act, 20 U.S.C. § 1232g. No one shall access any such records maintained in an electronic format or disclose or distribute their contents in any manner inconsistent with federal and state law and the institution regulations.

    The ability to access information does not imply permission to access it. Specifically, having read‐access to a file does not mean that you may read it. You should not browse, view, print, copy or execute someone else's directories or files (either manually or program‐assisted) without explicit permission. This also applies to floppy disks and tapes and similar storage media.

    There may be cases where supervisors must access an employee’s mail or files to get specific job‐related materials or conduct business. For example, an urgent memo must be sent, but the staff member who typed it is ill. The need to respond to business‐related email is another example. In all cases, unless prior arrangements have been made, reasonable effort to ask the employee's permission must be made.

    Access codes allocated for specific purposes may be designated as "non‐private." In such cases, no data stored under the code may be considered for the private use of the individual to whom the code is allocated. Prior notice of such designation must be given.

  7. Refrain from using ECF for unauthorized commercial activities.

    As with other institution resources, the use of the ECF for private, commercially oriented applications is forbidden without appropriate authorization. Use for institution‐related private activities is often permitted. For example, running an unauthorized business, doing tax returns or sending e‐mail soliciting donations for a non-institution‐related entity are clearly not allowed. On the other hand, use by a student for writing a resume is quite acceptable. If in doubt, check with the appropriate Instructor, Campus Director, Department Head, Executive Vice President or Executive Director.

  8. Refrain from using ECF for any unauthorized or illegal purposes. Such purposes might include destruction or alteration of data owned by others, interference with legitimate access to computing facilities or harassment of users of such facilities at the institution or elsewhere, unauthorized disruption of ECF, attempts to discover or alter passwords or to subvert security systems in ECF or in any other computing or network facility.

    The law prohibits unauthorized use of computers; unauthorized access to information or programs; destruction or alteration of data or interference with lawful access to data and the use of a computer system with the intent to commit any of the above.

    Intentional introduction of any computer virus, Trojan horse, worm or similar software is an explicit violation of this principle.

    Any unauthorized action which intentionally denies or obstructs access for another legitimate user to ECF is forbidden.

  9. Properly identify themselves in any electronic correspondence and provide valid, traceable identification if required by applications or servers within the ECF or in establishing connections from the ECF.

    All transmissions must be identifiable by the institutional staff. That is, they must include your access code. Similar rules are imposed by many external networks. You are encouraged to ensure that your name (in addition to access code) is also attached to all applicable messages. It is specifically forbidden to attempt to mask your real identity or intentionally originate a message masquerading as someone else.

    By convention, most systems offering "anonymous FTP" services request that you enter your network address as a password. Users must comply with this convention.

    Users do not have a right to privacy when using ECF.

    Users do not own accounts on the institution computers but are granted the privilege of use of accounts owned by the institution. Users have no ownership rights or reasonable expectation of privacy right regarding computer communications and data stored on institution computers or accessed through institution accounts.

    Institution officials have the right to access electronic files, including e‐mail files, for any purpose deemed reasonable by them in their sole discretion.

Any violation of this Code may be prosecuted in conformity with the relevant institution policy (Code of Student Conduct, personnel policies, etc.) as well as applicable criminal and civil laws.

I accept and agree to abide by the Code of Computing Conduct. I understand that compliance with the code is a condition of employment for all employees and a condition of enrollment for all students.

Felony Acknowledgment

Dear American National University Student,

This is to inform you that if you have ever been convicted of a felony or a misdemeanor you may be ineligible for participation in certain certification exams, may be ineligible to participate in certain externships, and/or may be unable to find employment in a field related to your education, regardless of the program of education you have selected.

Students enrolled in professional programs requiring certification testing

Please note that because of your enrollment in a professional program requiring certification testing, we want to be certain that you are informed that students or graduates who have been convicted of certain misdemeanors or a felony may be ineligible for participation in certification examinations in their respective field. Without certification you may be unable to find employment in a field related to your education. Additionally certain programs require certification testing as an element in one or more required courses. A student who is ineligible to participate in a certification exam in such a program will not be able to complete the program and/or graduate.

Students enrolled in programs involving externships

Many clinical/externship sites require a criminal background check prior to assignment of students to the site; background checks revealing a conviction for misdemeanors and/or felonies may make a student ineligible for placement at the site(s). Many clinical/externship sites also require a drug test prior to permitting assignment to the site; a positive result on a drug test may make a student ineligible for placement at these site(s). In either of these circumstances a student may not be able to be placed at any site, which would prevent the student from being able to complete the program and/or graduate.

Students enrolled in any program

Prospective employers seeking to hire individuals in any field may require a criminal background check, drug screening, etc. for employment. Having a history of a misdemeanor and/or felony, or failing a drug screening test may impair your ability to obtain employment. You may not be able to find employment in a field related to your education.

By signing below you acknowledge being informed of the effect that failing a drug screening test and/or having been convicted of a misdemeanor or felony may have on your ability to be placed in an externship, complete or graduate from your program of education, take a certification exam, and/or obtain employment in a field related to your education.

Identity Authentication Process and Student Consent to Disclose Records

The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student education records and gives students the right to authorize ANU to release information from his or her records to other people or to outside agencies. Students may wish to have information released via electronic means, requiring a process by which the University can authenticate the identity of the person requesting the information. This form provides the means by which students may authorize the release of information to other parties and a means to authenticate his or her identity prior to the release of information to him or her. Refer to the ANU FERPA Policy located in the University catalog or on the website ( www.an.edu ) for more information.

Section 1 – General Information

Section 2 – Student Authorization to Disclose Information from Education Records

Provide the information below for any person or agency to whom you authorize the release of some or all of your education records. If the release is for a person, security questions will be used by the University to authenticate the identity of this person prior to the release of that information.

I hereby give ANU permission to release the information indicated above to the agency or person(s) listed above.

Section 3- Authentication of Student Identity

Please provide the answers to at least three of the questions below. These will be used to validate your identity if you request information from your education record via some means other than in person (for example, by phone or through electronic means).

I hereby request that American National University use the above questions and answers to validate my identity in the event I request information from my educational record in a manner other than in person.

ONLINE EDUCATION DISCLOSURES AND CONSENTS FOR STUDENTS TAKING ALL COURSES ONLINE

Disclosures

  1. By completing and signing the electronic enrollment application, you are applying for acceptance to American National University to take online courses and conduct administrative activity in an electronic environment. To complete the application and to participate in online courses you must first consent to the use of electronic records. If you do not provide such consent, you will neither be able to apply for acceptance or to participate in online courses. There is no option to conduct business or receive instruction through the use of paper records in this environment. You will have the opportunity to provide consent or to withhold consent at the bottom of this page.

  2. Note that providing consent for the use of electronic records includes the consent to make application to the institution through the use of electronic records; to use an electronic signature to sign this consent page, the enrollment application and any documents requiring a signature in the future; and to conduct activities related to online courses, including administrative activity such as financial aid applications or other documents related to financial, academic or any other administrative activity, using electronic records and signatures.

  3. If you provide consent and begin online courses, then later wish to withdraw consent to use electronic records, you may do so by calling, writing or emailing the Online Student Services Office. This action will initiate the withdrawal process from any online courses in which you are registered and /or attending. All charges and fees will be assessed and/or adjusted according to the Refund Policy published in the university catalog.

  4. There are certain hardware and software requirements necessary for participation in online courses. If the requirements change, you will be notified. Presently, they are:

    • Desktop or laptop PC with DSL or cable internet, HD webcam, speaker with microphone or headset with microphone.
    • Internet Explorer 7.0 or higher; Firefox 3.0 or higher
    • Popup-­‐blocking disabled; JavaScript enabled; Ajax enabled
    • Adobe Reader and Adobe Flash installed
    • Java Runtime Environment 1.4 or higher
    • Windows XP, Vista or 7 with the most current updates installed; Macintosh OS/X or higher
    • Microsoft Office is required
    Note: Certain courses may require specific software. Before registering for a course, please contact your instructor or Online Student Services Representative for applicable software requirements.
  5. In order to protect your privacy and to ensure the integrity of the online education process, your identity must be authenticated by a third party. The university uses the services of Veratad for this purpose. If your identity is not verified through this process, you will be required to participate in a secondary authentication process. In that event, you must complete a secondary authentication form which must be notarized and submitted to the university. This form is available from your Online Student Services Representative.

  6. Your participation in online courses with American National University requires the use of certain “shared secrets,” such as a unique passcode to set up your American National University email account, and a unique login and password to access the Student Portal. Only American National University system administrators have access to this information. The University has strict protocols in place to prevent disclosure to unauthorized parties.

  7. Your University email account will be the primary means of communication with the university administration. If your account is not operational for any reason, contact the Online Student Services Office for assistance.

  8. You have the right to receive paper copies of items in your American National University electronic student file. These may be requested by contacting the Online Student Services Office.

Agreement and Consent

I have read and understand the information in the Disclosures section, above. I understand that my participation in online courses will require the use of “shared secrets” such as passcodes, logins and passwords. If I choose to participate in online course(s), I agree that I will not share or disclose these with others, and if I discover that another person has gained access to any of these, I will notify the Online Student Services Office immediately.

CPA Eligibility Form

All states have varying requirements to establish eligibility to sit for the CPA exam. Certain states accept regional accreditation only and other states accept national accreditation as well as regional accreditation. American National University is nationally accredited by the Distance Education Accrediting Commission (DEAC). Currently coursework taken and degrees earned at American National University is accepted toward the educational requirement to sit for the CPA examination in Virginia and Ohio. Individuals who intend to sit for the CPA exam in states other than Virginia or Ohio should not enroll in courses at American National University with the intent of using that coursework to qualify for the CPA exam or to transfer credits to another program at a different college and thereby qualify for the CPA exam.

Acknowledgment

This is to acknowledge that I have been fully advised of the above and that my enrollment in the program at American National University is not with the intent of sitting for the CPA exam in any state other than Virginia or Ohio. I understand that should I intend to sit for the CPA exam in the future, credits earned at American National University may not be accepted toward the educational requirement to sit for the CPA exam in states other than Virginia or Ohio.

Technical Standards Form

The goal of American National University is to prepare competent, entry-level professionals in their chosen field in each of the learning domains – cognitive, psychomotor, and affective. Thus, an individual must be able to independently, with or without reasonable accommodation, meet the following technical standards:

  1. Make accurate visual observations and interpret them in the context of patient care and laboratory studies.
  2. Communicate effectively with patients and members of the health care team.
  3. Have appropriate fine motor skills to provide general care or emergency treatment as indicated by situations, do basic laboratory tests, and carry out procedures.
  4. Be able to measure, calculate, analyze, and synthesize information needed for effective and timely problem solving.
  5. Possess emotional health needed to develop and maintain a professional and therapeutic relationship with patients and those who care for them, and cope effectively with the demands and obligations associated with medical education and patient care.
  6. Be able to accomplish each of the criteria and quality points listed in the college catalog for graduation.
  7. Be able to lift fifty (50) pounds without assistance and stand without difficulty for prolonged periods of time.
  8. Complete the certification below regarding communicable diseases.

Because certain communicable diseases present an unacceptable risk of transmission to others, particularly in a medical setting, applicants must certify whether or not they have a communicable disease known to them. If an applicant has a communicable disease they must be interviewed by the program director who will determine, based on the guidelines set forth in the college’s communicable disease policy, whether the applicant may be enrolled and, if so, what conditions must be met prior to and during the student’s enrollment. All applicants must complete the following certification by initialing the appropriate statement:

Additionally, applicants having been convicted of a felony may be ineligible for participation in national certification examinations in their respective field. Many clinical sites require a criminal background check prior to permitting assignment of students to that site; background checks that reveal conviction for misdemeanors and/or more serious crimes negate eligibility for placement at the site(s). Many clinical sites also require drug test prior to permitting assignments to that site; positive results on drug test may negate eligibility for placement at that site(s).

Students entering either program acknowledge by signing below that they have been informed that their required externship hours will be performed during the day. Medical assistants are placed in ambulatory health care settings that are generally open from 8 AM to 5 PM; surgical technologists are placed in clinical setting where surgeries are scheduled early in the mornings and are usually completed by mid to late afternoon. Students further acknowledge that they have been informed that due to site scheduling and availability students may have to wait to be placed at an externship site. Such a wait may extend completion of the externship until after the end of the student’s final academic term, in which case a student with loans may enter their grace period or even be required to begin repayment prior to completion of the externship.

Your signature below acknowledges receipt of these technical standards as well as placement for off-campus educational activities and affirms he/she is able to perform the functions as listed.

HIM Technical Standards

Technical Standards for Admission, Academic Progression and Graduation for Health Information Management Applicants

The goal of American National University is to prepare competent, entry-level professionals in their chosen field in each of the learning domains—cognitive, psychomotor, and affective. Thus, an individual must be able to independently, with or without reasonable accommodation, meet the following technical standards

  1. Make accurate visual and auditory observations and interpret them in the context of patient records.
  2. Communicate effectively with patients and all members of the health care team.
  3. Demonstrate appropriate gross and fine motor abilities sufficient to keyboard, file, and code. Use equipment, computers, and software.
  4. Ability to measure, calculate, analyze, and synthesize information needed for effective and timely problem solving.
  5. Possess emotional health needed to develop and maintain a professional relationship with patients and those who care for them, and cope effectively with the demands and obligations associated health information management.
  6. Complete each of the criteria and quality points listed in the college catalog for graduation.
  7. Be able to sit without difficulty for prolonged periods of time.
  8. Applicants having been convicted of a felony may be ineligible for participation in national certification examinations in their respective field. Many clinical sites require a criminal background check prior to permitting assignment of students to that site; background checks that reveal conviction for misdemeanors and/or more serious crimes negate eligibility for placement at the site(s). Many clinical sites also require drug test prior to permitting assignments to the site; positive results on drug test may negate eligibility for placement at that site(s). Proof of immunizations and vaccinations may also be required.
  9. Students entering the program acknowledge by signing below they have been informed their required externship hours may be scheduled during the day. Students further acknowledge they have been informed due to site scheduling and availability students may have to wait to be placed at an externship site or may need to travel a distance to participate in the externship. A wait may extend completion of the externship until after the end of the student’s final academic term, in which case a student with loans may enter their grace period or even be required to begin repayment prior to completion of the externship.
  10. Because certain communicable diseases present an unacceptable risk of transmission to others, particularly in a medical setting, applicants must certify whether or not they have a communicable disease known to them prior to their admission to the program. If an applicant has a communicable disease he/she must be interviewed by the program director who will determine, based on the guidelines set forth in the college’s communicable disease policy, whether the applicant may be enrolled and, if so, what conditions must be met prior to and during the student’s enrollment and externship.
  11. Your signature below acknowledges receipt of these technical standards as well as placement for off-campus educational activities/externship and affirms you are able to perform the functions as listed.
Transferability of Credits Form

Credits earned at American National University may not transfer to another educational institution. Credits earned at another educational institution may not be accepted by American National University. You should obtain confirmation that American National University will accept any credits you have earned at another educational institution before you execute an enrollment contract or agreement. You should also contact any educational institutions that you may want to transfer credits earned at American National University to determine if such institutions will accept credits earned at American National University prior to executing an enrollment contract or agreement. The ability to transfer credits from American National University to another educational institution may be very limited. Your credits may not transfer and you may have to repeat courses previously taken at American National University if you enroll in another educational institution. You should never assume that credits will transfer to or from any educational institution. It is highly recommended and you are advised to make certain that you know the transfer of credit policy of American National University and of any other educational institutions you may in the future want to transfer the credits earned at American National University before you execute an enrollment contract or agreement.

I have been given a copy of this statement prior to executing an enrollment agreement or contract.

HIM Enrollment Agreement Disclosure

The online Health Information Management (HIM) program is a program designed to implement the new Academic Competencies established by American Health Information Management Association’s (AHIMA) Council for Excellence in Education. American National University (ANU) has applied for accreditation by Commission on Accreditation for Health Informatics and Information Management (CAHIIM) for this HIM program. ANU cannot guarantee that the application for candidacy will be accepted or that accreditation will be granted.

If the application is accepted the program will be in an applicant candidacy status while being reviewed by CAHIIM. The accreditation process is not complete until the program is awarded an accreditation decision by CAHIIM. Candidacy does not provide eligibility for enrolled students to apply for the AHIMA entry‐level certification examination for Registered Health Information Technician (RHIT).

Students may not apply for the exam until formal accreditation is awarded. If the program does not become accredited students and graduates will not be eligible to apply for the AHIMA certification exam.

If the program does receive accreditation, both enrolled students and graduates will be eligible to apply for the exam. If accreditation occurs after the student has graduated he or she will be notified so that they can apply for AHIMA certification exam.

Without the CAHIIM accreditation students can still apply and complete coding certification exams such as CCS, CCA, or CCS‐P after graduation.

http://www.cahiim.org/applyaccredunder.html

http://www.ahima.org/certification


Certification Testing:

Please note that because of your enrollment in a professional program requiring certification testing, we want to be certain that you are informed that students or graduates who have been convicted of certain misdemeanors or a felony may be ineligible for participation in certification examinations in their respective field.

Externship Requirements:

It is expected that the clinical externship will be conducted in the last term of a student’s HIM program. It is the responsibility of student to make an appointment with program director or faculty responsible for externship placements a term before the graduating term to discuss opportunities. The school will work with the student to arrange for an internship at an external site.

Many clinical/externship sites require a criminal background check prior to assignment of students to the site; background checks revealing a conviction for misdemeanors and/or felonies may make a student ineligible for placement at the site(s). Many clinical/externship sites also require a drug test prior to permitting assignment to the site; a positive result on a drug test may make a student ineligible for placement at these site(s). In either of these circumstances a student may not be able to be placed at any site, which would prevent the student from being able to complete the program and/or graduate.

Students will be required to obtain vaccinations in order to participate in externships.

Employment

Prospective employers seeking to hire individuals in any field may require a criminal background check, drug screening, etc. for employment. Having a history of a misdemeanor and/or felony, or failing a drug screening test may impair your ability to obtain employment. You may not be able to find employment in a field related to your education.

By signing below you acknowledge being informed of the effect that failing a drug screening test and/or having been convicted of a misdemeanor or felony may have on your ability to be placed in an externship, complete or graduate from your program of education, take a certification exam, and/or obtain employment in a field related to your education.



I have applied to American National University for admission. Prior to acceptance by American National University, the college must have a final transcript showing that I am a high school graduate or GED/HISET recipient. Please use this form as my formal request to release to American National University/National College my official documents. (A faxed copy of my documents will be accepted by American National University if a fax cover sheet from your institution is included).

You will be provided with the fax number and mailing address of the requesting American National University Campus.

Thank you for your timely response.

The following information may help in locating my records:


I understand that I am allowing American National University to solicit my transcripts and immunization records(Tennessee locations). I hereby give my permission for the release of my transcript and immunization record (Tennessee locations) to American National University for the purpose of admission.
*This release form has been signed to meet the requirements of the Family Education Rights and Privacy Act of 1974 (Buckley Amendment)


Immunization Verification Form

Section 1 - Student Information

New fulltime students enrollingafterJuly1,2011 aretoverifytheycomplywiththe following immunizationrequirements. (Tennessee Department ofHealth Rule 1200-14-1-29, revised December 2009)


Section 2 – Immunization Verification

Students who need 2 doses of vaccine, but cannot get both doses before classes start may enroll with documentation of one dose of each required vaccine but must have documentation of the 2 nd dose completed prior to registration for the next term.

Check the appropriate type of documentation for each immunization:

Measles, mumps and rubella immunity:

  • Proof of immunity to measles, mumps and rubella may be provided by meeting one of the following 3 criteria:

Varicella (chickenpox) immunity:

  • Proof of immunity to varicella (chickenpox) is required by meeting one of the following 4 criteria:

Hepatitis B immunity (Medical Assisting and Surgical Technology students only):

  • Proof of immunity to hepatitis B for students in health sciences prior to patient care duties may be documented in one of the following ways:

Section 3 – General Information

Location of Immunization records: Adults can have difficulty locating childhood immunization records. They should check with family members who may have copies of childhood records. They should try to contact the original immunization provider: if a local health department, contact them directly; if a private medical office, contact that office. Schools may have copies of immunization certificates in student files. Children born after the mid-1990s may have records entered in a state-managed immunization register; such registries now exist in many states but are unlikely to contain information on adults. If records cannot be located, vaccination is recommended – additional doses of vaccine are not harmful.

Exceptions to the requirements:

  1. Medical: Physician or health department indicates that certain vaccines are medically exempted (because of risk of harm). Any vaccines not exempted remain required.
  2. Religious: Requires a signed statement by the student that vaccination conflicts with his or her religious tenets or practices.

MEN’S BASKETBALL - ATHLETE FORM

SECTION 2 - HIGH SCHOOL INFORMATION


CDL Training Admission Requirements

Must be 18 years of age or older

Have held a driver’s license for the past three years within the United States

Reside in any state EXCEPT Illinois, Maryland or South Carolina (if you live in these states, you must obtain your Commercial Driver's License in your respective state)

Have original or certified (sealed) copy of birth certificate to get a permit from the DMV and to take your CDL test

Understand highway traffic signals and signs

Have basic fundamental skills to read, write and speak English, as per Federal Motor Carrier Safety Regulations. (§391 FMCSR)

Be a lawful, permanent resident of the United States or have a current valid VISA or work permit to work in the United States

Must obtain a seven (7) year MVR with no convictions in the past 3 years of any of the following: DUI, refusal to take a chemical test, hit and run, leaving the scene of an accident, or careless/reckless driving

I acknowledge I must take and pass a DOT physical and drug test prior to the first day of training

Personal Information


Background Information

This includes traffic citations and accidents.

COVID-19 Emergency Conditional Acceptance Disclosure

Students enrolling in the Pharmacy Technician Diploma or Pharmacy Technician Associate Degree program at American National University are required to submit to a criminal background check as a condition of enrollment. Normally receipt of a criminal background check disclosing no drug-related misdemeanor conviction or any felony conviction is required prior to beginning instruction. However, the processing of criminal background checks has experienced substantial delay due to conditions resulting from the COVID-19 emergency.

Therefore students who have completed and submitted applications for a criminal background check will be conditionally enrolled for a maximum of two academic terms pending the results of the criminal background check. The enrollment will automatically convert to full acceptance once a background check showing no felony convictions is received. In the event a background check disclosing a drug-related misdemeanor conviction or a felony conviction is received the conditional enrollment will be rescinded, the student will be withdrawn from classes, and all payments to the University for enrollment in the Pharmacy Technician program will be refunded.

By signing below you acknowledge and accept the terms of your conditional acceptance to enrollment at American National University as explained above.