Program Handbook - Medical Assistant

* = required field

Some content may be updated based on selection

Lakeshore College Program Handbook Acknowledgement for the:

Medical Assistant Program

Student Information

Student ID Number:

First Name:

Last Name:

As a student taking courses in the Medical Assistant Program, you are expected to abide by the following:

Read the statements below and check each box to identify that you have read and understood them.

Initials

I have read and understand the Medical Assistant Program Student Handbook and currently agree to abide by its policies and guidelines. I understand that in the future, I am responsible to access and know the information included in the most current version of the handbook available on the Lakeshore College website. I will contact the Medical Assistant Program Coordinator or Academic Counselor if I have any questions about the content of the handbook.

Initials

I acknowledge the program's Technical Standards and am aware of my ability to discuss these with an Academic Counselor and/or request accommodations through Lakeshore College's Accommodation Services.

Initials

I acknowledge that my enrollment in a required clinical/practicum, tactical courses, and/or employment opportunities is conditioned upon a clearance following review of my Background Information Disclosure, and confirmation of the accuracy of the information through the Wisconsin Department of Justice.

Initials

I acknowledge that from the time I complete the Background Information Disclosure until I graduate from, or drop the program, if I am charged with or convicted of a crime or municpal ordinance violation of any type, before any court, or if I am investigated for any violation of local, state, or federal law, I must report this to my Lakeshore College Dean within one (1) school day.

Initials

I acknowledge that the result of my background check and any subsequestnt investigation, charge or conviction, may cause me to be barred or suspended from a clinical/practicum, tactical courses, and/or employment opportunities.

Initials

I acknowledge that a charge or convition may delay or prevent my graduation from the program , as well as delay or prevent receiving my applicable certification or licensure.

Initials

I acknowledge that my failure to report any required information may prevent enrollment in any clinical/practicum or tactical courses and could result in dismissal proceedings.

Initials

I acknowledge that a further background check could be conducted prior to my enrollment in any clinical/practicum, tactical courses, and/or employment opportunitites.

Initials

I acknowledge that all bacground checks are obtained at the expense of the student.

Initials

I have read, understand, and been given the opportunity to ask questions about the requirements and expectations of a student taking courses in this program.

Initials

I understand that if I do not follow and abide by these requirements and expectations that I may be subject to progressive discipline up to and including removal from this program.

My signature below confirms that I understand and agree to the above. I also understand that typing my name in the box provivded below is the equivalent of placing my signature on a document.

Student Signature

Date

This form is to be signed at the time of program enrollment and as program policies or needs change.

Lakeshore College does not discriminate against protected classes, including but not limited to race, color, national origin, religion, sex, or gender – including sexual orientation, gender identity, gender expression, disability or age in employment, admissions, or its programs or activities. To handle inquiries regarding Lakeshore's nondiscrimination policies, contact Vice President of Student Succes 920.693.1818, Tanya.Boman@lakeshore.edu / EXECUTIVE DIRECTOR OF HUMAN RESOURCES (staff/others) 920.693.1139, Marissa.Holst@lakeshore.edu. 1290 North Avenue, Cleveland, WI 53015. TTY 711 lakeshore.edu/equal-opportunity-statement 2025

Please wait for files to finish uploading