Personal Information

Name*
Address*

Northwestern Memorial Healthcare welcomes students from all backgrounds and is dedicated to providing equal opportunity to applicants. The program does not discriminate in the recruitment and admission of students or in the operation of its educational programs or activities. Applicants are considered for admission based on individual merit and without regard to age, race, color, national origin, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, gender identity or expression, marital status, parental status, military or veteran status, or source of income in the provision of educational services.

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Northwestern Medicine Employment

Are you an employee of Northwestern Medicine?*
If yes, please specify schedule status:*
Start date (month/year) of employment at NM: *

Education

What is your highest level of education:*
Did you graduate from a Chicago Public Schools (CPS) high school?*

Work Experience

Work Experience 1

Start date:*
End date:*

Work Experience 2

Start date:
End date:

Work Experience 3

Start date:
End date:

NM Academy: Medical Assistant (MA) Program

Please attach your personal statement.*
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I have requested official transcripts from my high school/GED completion or degree program (if applicable) to be sent to the NM Clinical Schools Registrar.*
Have you ever been suspended, dismissed, or expelled from an education program that you attended?*
I have requested submission of (1) NM Medical Assistant Program Letter of Recommendation Form.*
I have read the attached Medical Assistant Program Technical Standards and understand the cognitive, psychomotor and affective requirements for the program. I am able to meet the program technical standards.*

Application fee: $25

IMPORTANT: If paying with credit card, you will be directed to payment site and will be prompted to create an account at checkout.  You must RETURN TO THIS APPLICATION and click SUBMIT FORM in order to successfully submit your online application. 

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I have submitted a $25 application fee by credit card
I have submitted a $25 application fee by check
How did you hear about the NM Medical Assistant Program?*
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