Health Sciences Department
Kapi`olani Community College
MEDICAL ASSISTNG PROGRAM
Admission Application Checklist
Priority Application Period: December 1 – March 1
Directions: Please complete each item carefully and submit this Admission Application Check List and all required
documents to a Health Sciences Counselor during office hours at the Health Career Counseling Center in Kauila 106. If
the application deadline falls on a weekend or holiday, applications will be accepted on the following business day.
Only this fully completed program Admission Application Checklist submitted to the Health Career Counseling
Center (Kauila 106) by the appropriate deadline (see above) will be accepted for processing.
APPLICANT INFORMATION
Name:
UH Number/Username
Last Name
First Name
M.I.
Mailing
Address:
Street / POB
City
State
Zip Code
Phone:
Cell
Home
Work
UH SYSTEM Email Address:
List other name(s) used on documents:
(Notify the KCC Kekaulike Information & Service Center regarding other names used on college documents.)
ADMISSION APPLICATION CHECKLIST FOR MEDA PROGRAM
1.
Attend a Mandatory MEDA Program Information Session.
For more information visit www.kapiolani.hawaii.edu or pick up an Information Session schedule from
Kauila 122 or Kauila 106, Monday – Friday from 8:00 AM to 4:00 PM.
Date Attended:
(Month / Day / Year)
2.
Complete the online UH System Application (New, Returning or Transfer) if you are not currently
enrolled at any UH System institution. (http://apply.hawaii.edu)
3.
Complete all MEDA qualifying tests or equivalent courses prior to the end of the application
period. Math qualification must be within the last two years.
4.
Student copy of transcripts (for course work WITHIN the UH System). UH system transcripts can be
downloaded from your MyUH Portal. Student copies of transcripts must be submitted with this checklist.
5.
College transcripts for courses completed outside of the University of Hawai‘i System
Official transcript(s) should be sent to the KCC Kekaulike Information & Service Center.
• Institution:
Transcript Request Date:
• Institution:
Transcript Request Date:
• Institution:
Transcript Request Date:
1/28/2016
Health Sciences Department
6.
Online request for Transcript Evaluation - A request for transcript evaluation must be completed for
coursework outside the UH System. Completion of this online form is required in order to transfer credits
to KCC. This form can completed online at:
http://makahiki.kcc.hawaii.edu:8080/opinio/s?s=4154
7.
Typing Test – A typing test is required as part of the application process. Details regarding the test date
will be provided after your completed application is reviewed.
8.
Work/Volunteer Experience – You will be given points for any work/volunteer experience you have. You
will be given a verification form to complete when you come in for your typing test.
9.
“My Plan Initiative.” Complete reflection essays and self assessments for your program/career pathway.
10.
Self-addressed, stamped #10 (4 1/8” X 9 1/2") envelope.
APPLICANT CERTIFICATIONS:
I certify that the answers and responses provided for all of the items on this Admission Application/Check List are true to
the best of my knowledge and belief. I understand that providing incorrect or false information will subject me to the
requirements and/or discipline measures as provided under the University’s Student Conduct Code. I understand that if I
am not accepted into the program of application, I must submit a new application and all required documents for any
subsequent semester. I also allow KISC to change my major and home institution if I am accepted into the MEDA
program. I understand that if I am not accepted into the MEDA program, my home institution and major will not change.
“Health care students are required to complete University prescribed academic requirements that
involve practice in a University affiliated health care facility setting with no substitution allowable
for the completion required clinical practice. Failure of a student to complete the prescribed
clinical practices shall be deemed as not satisfying academic program requirements. It is the
responsibility of the student to satisfactorily complete any criminal background checks and drug
testing that may be required by the affiliated health care facility to which he/she is assigned for
clinical practice in accordance with procedures and timelines as prescribed by that affiliated
health care facility.”
I have read and understand the notification that a criminal background check and drug test may be required for entry into
clinical practice. I also understand that clinical practice is required for completion of this program. ________ (please
initial)
Print Name ____________________________ Signature ________________________
Date_____________
EXAMPLE of how to complete the application:
 These are the requirements 
Required before application deadline
COMPASS Placement Test Score of
Math 24 or higher OR Completion of
PCM 23 or higher.
COMPASS Reading Test Score of 74 or
higher OR Completion of ENG 22
Beginning Composition (3).
 Fill in the information about the class you took to meet each requirement 
Test Score OR
Course Alpha
Term of
Completion
Where Completed
(i.e., Institution)
Grade/Credit
Math 100
Spring 2016
LCC
A/3.0
Placement into
ENG 100
Date of Test:
1/12/2016
KCC Testing Center
N/A
1/28/2016
Health Sciences Department
Medical Assisting
Qualification
Prerequisites
Required for admission
Course
Alpha/Test
Score
Term of
Completion
Institution
Name
Grade/
Credits
Qualification for Math 32
or higher
(must be within the last two
years)
Qualification for ENG
100
Total prerequisite
points
(required for admission)
A.S. Degree General
Education
Requirements
(Program Support
Courses)
Course Alpha
Term of
Completion
Institution
Name
ENG 100 Composition I
(3)
MATH 100 Survey of
Mathematics (3) OR
higher
FAMR 230 Human
Growth & Development
(3)
ZOOL 141 Human
Anatomy & Physiology I
(3)
ZOOL 141L Human
Anatomy & Physiology I
Lab (1)
A. S. Humanities
elective (100 level or
higher) (3)
Date Received: _____________________
Ethnic Code: ____________
Counselor’s Initials: _________________
Application Complete: _____________
HI Resident:
Y
Yes
3
No
0
Yes
3
No
0
_____ / 6
Grade/
Credits
* not required for admission *
Application Summary: For office use only
Points
Total support points
(not required for
admission)
Points
Yes
1
No
0
Yes
1
No
0
A
3
B
2
C
1
A
3
B
2
C
1
A
3
B
2
C
1
A
3
B
2
C
1
___/14
N
KCC GPA Verified: _______________
1/28/2016
Health Sciences Department
Kapi`olani Community College
MY PLAN
Reflection Essays
Name: _____________________________________ UHID: ________________________________ Program: _______________________________________________________________ Please be clear and concise in your response for each reflective essay, limiting each question to 300 words. Career Pathway Preparation 1. In a brief statement describe your career goals in this pathway. Where do
you see yourself in this career pathway in the next three years? Health Sciences Department
Career Pathway Attributes 2. In viewing “Health Careers at a Glance”, what are your strongest and
weakest “professional qualities” in your chosen career pathway? Please
describe these attributes; how do you plan to overcome your challenges,
how do you plan to improve on your strengths?
Health Sciences Department
Career Pathway Outlook 3. Describe any personal obstacles you face that may impact your current
academic success and how you plan to overcome these challenges? (I.e.
transportation, financial obligations, child care, time management). What
support systems do you have in place to overcome them?
Health Sciences Department
Kapi`olani Community College
MY PLAN
Self - Assessment
The purpose of the self-assessment is to discover your strengths and areas of focus. Working in healthcare
requires a combination of academic skills, social skills, and a commitment to public service. As you plan, find
ways to make your strengths shine and to improve your weaker areas. Consider discussing your selfassessment and reflective essays with a counselor to understanding how they support your academic and
career goals.
Academic Strength
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Cumulative GPA
Prerequisite Course GPA
Completed prerequisites
Completed support courses
Writing ability
Letters of evaluation
Awards/Achievements
Knowledge of the Profession
Relevant experience – volunteer
Relevant experience – for credit
Relevant experience – paid
Relevant Public service/Service Learning
Understanding of current healthcare issues
Comfort with bodily fluids
Comfort with illness
Comfort with injury
Comfort with death
Comfort with physical contact with people
Ability to multitask and adapt to change
Personal Characteristics
Commitment to public service
Empathy/altruism
Moral/ethical integrity
Emotional maturity
Responsibility
Leadership
Dedication/hard-working
Commitment to life-long learning
Ability to work as a team
Personal interests & experience
HEALTH CAREERS COUNSELING CENTER
HEALTH CAREERS @ A GLANCE FOR HEALTH SCIENCES/EMS
All programs give priority seating to qualified Hawai`i state residents. Each student should develop a “My Plan” with the Health Sciences/Nursing Counselor(s) for their intended program/career pathway.
Program
Dental Assisting
(DENT)
Emergency
Medical Technician
(EMT)
Medical Assisting
(MEDA)
Medical
Laboratory
Technician (MLT)
Mobile Intensive
Care Technician
(MICT)
Health Services
Occupational
Cluster
Professional Qualities
Starting
Semester
Application
Period
Selection
Process
Selection
Criteria
Qualifying
Placement Tests
Therapeutic Dental
Professional Attitude
Time Management
Compassion
Flexibility
Adapt to Changes
Ability to Multitask
Fall
Dec 1 - June 30
Best Qualified,
First Accepted
Cumulative Score
from Completed
Prerequisites
COMPASS
Reading score of
74 or higher
Therapeutic
Direct Patient Care
Integrity
Empathy
Self Motivation
Appearance & Hygiene
Self Confidence
Time Management
Communication Skills
Teamwork & Diplomacy
Respect
Patient Advocacy
Best Qualified,
First Accepted
Cumulative Score
from Completed
Prerequisites, Supplemental Application Requirements, &
Interview
COMPASS
MATH 24 or
higher or
evidence of
completion
Therapeutic Patient Care,
Health Info & Diagnostic
Compassion
Attention to Detail
Ability to Multitask,
Organizational Skills,
Good Verbal & Written
Communication Skills
Adaptability & Flexibility
Best Qualified,
First Accepted
Qualifying Scores/
Courses
Qualification for
ENG 100 &
Qualification for
MATH 32 or
higher;
Or evidence of
course completion
Diagnostic Laboratory
Attention To Detail
Integrity
Dependability
Good Verbal & Written
Communication Skills
Self-Starter
Ability To Multi-Task
Best Qualified,
First Accepted
Cumulative Score
from Completed
Prerequisites &
Support Courses
Therapeutic
Direct Patient Care
Integrity
Empathy
Self Motivation
Appearance & Hygiene
Self Confidence
Time Management
Communication Skills
Critical Thinking * Problem
Solving Skills
Teamwork & Diplomacy
Respect
Patient Advocacy
Best Qualified
Cumulative Score
from Completed
Prerequisites, Supplemental Application Requirements, &
Interview
Information is subject to change without notice.
Fall
Spring
Fall
Spring
Spring
Dec 1 - June 1
June 2 - Oct 1
Dec 1—March 1
June 1—Sept 1
June 1—Oct 1
(every other year)
Prerequisites
ENG 100 or ESL 100
Math 100 (or higher)
SP 151
ZOOL 141 + 141L
Suggested
Degree
Support Courses (Credits)
None
CC: 15
CA:41
English 100
Health 125
MATH 24 or
Equivalent
coursework
None
CC:13
ENG 100
MATH 100
ZOOL 141 + 141L
FAMR 230
AS/AH
None
CC:33
AS:64
None
ENG 100 or ESL 100
MATH 103 or higher
CHEM 161 + 161L
MLT 100
BIOL 130 or
BIOL 171 or
ZOOL 141 &
ZOOL 142
CHEM 162 + 162L
MICR 130
MICR 161
AS/SS
AS/AH
AS:70-73
None
ENG 100
HLTH 125
MATH 103
EMT 100
EMT 101
BIO 130 + 130L or
ZOOL 141,141L, &
142,142L
FAMR 230
AS/AH
CC:44
AS:69
Updated: 1/28/2016
HEALTH CAREERS COUNSELING CENTER
HEALTH CAREERS @ A GLANCE FOR HEALTH SCIENCES/EMS
All programs give priority seating to qualified Hawai`i state residents. Each student should develop a “My Plan” with the Health Sciences/Nursing Counselor(s) for your intended program/career pathway.
Program
Occupational
Therapy Assistant
(OTA)
Physical Therapist
Assistant (PTA)
Radiologic
Technician
(RAD)
Respiratory
Care Practitioner
(RESP)
Health Services
Occupational
Cluster
Personal Qualities
Therapeutic
Rehabilitation
Able to Relate & Engage With
People; “people person”
Self Motivated & Responsible
Organizational Skills
Commit To Rigorous Study
Communication Skills
Critical Thinking Skills
Creative & Adaptability
Teamwork Skills
Therapeutic
Rehabilitation
Accountability
Altruism
Compassion and Caring
Culture Competence
Duty
Integrity
Social Responsibility
Communication
Problem Solving
Diagnostic Imaging
Communication Skills
Compassion
Hand-Eye Coordination and
Visualization
Acute Problem Solving Skills/
Ability to Adapt
Function Under Pressure
Good Work Ethic
Therapeutic
Direct Patient Care
Communication Skills
Compassion and Caring
Culture Competence
Ability to Adapt
Ability to Multitask
Organizational Skills
Problem Solving Skills
Integrity
Teamwork & Diplomacy
Good Work Ethic
Information is subject to change without notice.
Starting
Semester
Fall
Fall
Fall
Summer
Application
Period
Selection
Criteria
Qualifying
Placement /Tests
Best Qualified,
First Accepted
Qualifying Scores/
Courses
COMPASS ENG
100, & COMPASS MATH 24
or higher, or
evidence of
completion of
both
Apr 1—May 25
Best Qualified,
First Accepted
Cumulative Score
from Completed
Prerequisites &
Observation
Reference Score
Apr 1—May 31
Best Qualified,
First Accepted
Cumulative Score
from Completed
Prerequisites &
Support Courses,
& A2 Exam
Best Qualified,
First Accepted
Cumulative Score
from Completed
Prerequisites,
Interview, Essay,
& Evidence of
Degree Earned
April 1—May 30
April 1— May 30
Selection
Process
Prerequisites
Suggested
Degree
Support Courses (Credits)
HLTH 125
OTA 110
OTA 119
AS/AH
FAMR 230
CC: 5
AS: 70-72
ENG 100 or ESL 100
MATH 100 or higher
BIOL 130, 130L or
ZOOL 141,141L +
142,142L
None
ENG 100 or ESL 100
MATH 103 or higher
SP 181
FAMR 230
ZOOL 141,141L,
142,142L
PTA 101W
HLTH 120
HLTH 125
HLTH 290, 290L
AS/AH
None
AS:72
HESI A2 Exam
ENG 100 or ESL 100
MATH 135 or higher
HLTH 125
BIOL 130 + 130L or
ZOOL141,141L,
142,+142L
AS/AH
AS/SS
AS: 89-92
None
ENG 100 or ESL 100
MATH 100 or higher
HLTH125 or HLTH110
PSY100 or FAMR230
CHEM100 or higher
ZOOL141,141L,
142,+142L
MICR 130 or MICR 135
MICR 140
AS/AH
None
AS: 67-68
Updated: 1/28/2016