Health Information Technology Program
Distance Learning Candidate Information Form
(Please complete 4-page form, save and return in same Word format to
underwoodj@edgecombe.edu AND everetten@edgecombe.edu )
Applicant Full Name:
Social Security Number: (last 4 digits):
Date of Birth:
ECC Student Email Address: (firstinitial+lastname+ birthmo&date) ex.” jdoe0214”@myedge.cc
With this format, following registration of classes, your student email will be:
Personal Email Address:
Street Address:
City/State/Zip Code:
Phone # with area code: Cell ( ) ; Hm ( )
; Wk ( )
STRUCTURED QUESTIONS FOR HIT CANDIDATE:
(This is a 4 page, 15 question application – please retain this format. Thank you!)
HIT (TWO) ADMISSION DEADLINES: Fall Term (June 1), Spring Term (October 1);
Prior College Degrees: [ ] Assoc (yr/college); [ ] Bachelor’s (yr/college); [ ] Master’s (yr/college);
Please specify degrees above:
Date of application: _______ Time of application: _______ (am/pm):
I would like to begin my HIT studies: Fall [ ], Spring [ ], Summer- PRE-ADM studies only [ ]
I would like to graduate in: 1 yr [ ]; 2 yrs [ ]; other, specify year - _______
1. How did you learn about the Health Information Technology Program at Edgecombe
Community College? (We always want to give special thanks to our many friends that spread
the good word about our program and help lead you to a brighter future!)
2. What is YOUR reason for choosing Health Information Technology as a career path?
3. What do you see yourself doing ten (10) years from now?
4. Identify one word that best describes YOU as a person:
Why?
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5. Why are YOU the “best student applicant that we have ever interviewed? (Why should you be
admitted into the HIT program?)
6. What, to your best understanding, are the duties of a Health Information Technician?
7. Do you have any previous hospital/health care facility work experience? (Where, doing what
and for how long?)
8. What are the most important rewards that you expect in your career?
9. What do you consider to be your greatest weakness?
10. What do you consider to be your greatest strength?
11. What qualifications do you have that make you think that you will be successful in the Health
Information Technology program?
12. Describe your most rewarding educational experience thus far?
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13. In what kind of work/clinical environment do you think you will be most comfortable? (Small
office, large group practice, small hospital, large hospital, teaching facility, etc?)
14. How do you work under pressure?
15. Will the travel schedule for clinicals required by the HIT Program be a problem for you?
Your answer here:
[Please know that regional HIT students (within 75mi radius of ECC) travel to approximately 16 different sites as a
class/group, in HIT 122 “OL1” section, Professional Practice Experience I (PPE I), in the fall semester of their first
year. Sites may range from as far away as the cities of Wilmington/New Bern/Goldsboro to the east and
Raleigh/Cary/Durham to the west. Students are responsible for their own transportation to and from clinical sites
for all PPEs in the first and second year. Distant HIT students (greater than 75 mi radius from ECC &/or out of
state- HIT122 “OLD” section): Clinicals will be worked out with you on an individual by individual basis with
hospitals in your local area that are willing to contract with ECC HIT as a clinical affiliate site and accept
assignment of you as a student for your clinical courses needed. We normally do not run clinical courses in the
summers due to low staffing levels in Hospital HIM Departments impacted by vacations & summer holidays, so it is
imperative that students take clinical courses when they are offered in the Fall and Spring terms to progress in
their studies adequately. ANY clinicals are ALWAYS pending hospital availability and their willingness to take
student assignments; which are beyond the control of the college or the HIT program. The decisions of hospitals
may be varied due to workload and/or current staffing demands.
Students employed while in HIT program are encouraged to negotiate alternate work schedules with their
supervisors in advance of admission to the HIT program. Clinical courses such as HIT122 PPE I – are on
Mondays from 2-5pm; students need to plan to take off at 12Noon, using their lunch hour (12-1pm to eat on the
road & travel to clinical site for clinicals from 2-5pm. By working an additional hour on the remaining work days
(Tuesday through Friday) students may balance their work hours and productivity by making up the four (4) work
hours missed on Mondays from 1-5pm ).
Similar schedule alterations can be accomplished with senior clinical courses, HIT 222 & 224 (PPE III & IV), in
which you will be absent the entire day on Tuesdays throughout the semester and those 8 work hours will need to
be altered throughout the existing workweek. If students are not supported by their employers and able to alter
their work schedules, they will need to consider another program of study or take their clinical courses at the end of
their studies when employment “termination” may be an option for you. However, clinicals are an integral
component of our students’ workplace learning experience in the HIT program and although this is not the ideal
method recommended, taking clinical courses at the end of your studies will work, if necessary.
To meet the requirements of workforce and students of all healthcare settings, students must be able to pass a
“criminal background check” for the past seven years for every county and state resided in since the age of 18 and
be able to pass a drug screen, when required. If unable to meet these requirements of our affiliate facilities, they
will NOT be cleared for clinical and thus students will NOT be able to fulfill clinical requirements; therefore, be
required to change their major and exit the HIT program.]
Any additional comments you would like to add to this interview document?
(Please continue to final page: page 4 of 4)
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[The information below is simply to help us to get to know you, a totally online student, better as a
new member of the ECCHIT Distance Learning family. If you would rather not share this information
it is perfectly ok; this is up to you. Please be assured that it will not be released to anyone and is
solely for the use by HIT program.]
Personal Information (respond, as desired)
Parents and/or Spouse, if married:
No. Brothers:
No. Sisters:
No. Children: _____ (boys) _____ (girls)
Work Place:
Work Duties:
High School attended:
College(s) attended:
Current Degree(s):
Grad Yr:
Grad Yr:
Favorite Subject:
Special Activities Involved in:
Hobbies, Interests, etc:
Personal Favorites:
Food:
TV Program:
Actor:
Actress:
Movie:
Book:
Color:
Sports Team:
Car:
Musical group/individual:
Song:
Place:
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