Course Completion

Please complete the following information necessary in moving forward with finishing your program.

Student Name:  

Document Sent Date:

Course completed:  

Eligible Observation/Externship Program and Requirements:

Clinical Medical Assistant (CMA): CPR/BLS Healthcare Certification (cannot be online test) & TB (Tuberculosis) skin test. (Hepatitis B vaccine, Drug Screening and Background Check might be necessary based on the facility). Proof of good standing with school loan, if tuition is financed.

Pharmacy Technician (PhT): CPR/BLS Healthcare Certification (cannot be online test). State Registration, Drug Screening and Background Check. Proof of good standing with school loan, if tuition is financed.  

Dental Assistant (DA): CPR/BLS Healthcare Certification (cannot be online test) & Hepatitis B vaccination (Drug Screening and Background Check might be necessary based on facility). Proof of good standing with school loan, if tuition is financed.

Please select by initialing and signing your agreement.

Terms and Conditions of Not Participating in Optional Observation/Externship: 

  1. By rejecting to complete the optional observation hours, I understand I am now a graduate of my enrolled program. I will be sent my Exit Interview link to complete graduate survey information to release my certificate of completion and transcript. Proof of good standing with school loan, if tuition is financed.


Terms and Conditions of Participating in Optional Observation/Externship: 

  1. By accepting to complete the optional observation hours, I am responsible for submitting proof of up to date records for the items listed below (dependent on course completion) and understand that this must be electronically submitted to the instructor(s) no later than 10 days after this form is completed. *Failure to do so will result in the school no longer being held responsible for locating an observation site.* 
  2. By accepting to complete the optional observation hours, I understand that I must have required Student Placement of Observation Site form completed and submitted to the instructor(s) no later than 7 days after being sent. *Failure to do so will result in the school no longer being held responsible for student being placed in an observation site nor complete any hours.
  3. By accepting to complete the optional observation hours, you are understanding that TMIKY can place you within 100 miles of your residential address. 
  4. By accepting to complete the optional observation hours, I understand that I must submit my Observation/Externship Timesheet weekly of accurate documented hours, signed by myself and the hosting facility.

Externship/Observation Syllabus and Guidelines:


  1. Students must have 70% completion grade in their program
  2. Student must supply proof they are current with their school financials
  3. Externship Guidelines Agreement form signed 
  4. Externship Confidentiality Agreement signed
  5. OSHA Standards form signed
  6. Hepatitis B waiver/consent signed
  7. Current TB Skin Test submitted
  8. Current CPR for Healthcare providers if required
  9. Completed the program HIPAA/OSHA training 

Program Description: 

The externship/observation provides an opportunity for students to experience working in a healthcare setting. The student will perform both clinical and administrative duties while being supervised and evaluated by the office staff and monitored by the instructor. All students enrolled in an observation/externship required program will complete 40 hours at their clinical site. 

The Medical Institute of Kentucky only assumes responsibility for the performance and action of the clinical student while in a clinical facility during the times specified as a clinical learning experience and when under the supervision of the externship supervisor. 

Externship/Observation Objectives:

Within the setting of a healthcare facility the student will:

  1. Utilize the basic skills and knowledge gained by completing their program.
  2. Positively relate with and understand the role of the office manager, provider(s), and staff, so as to become a valued member of the team.
  3. Positively relate with patients and their families in person and on the phone using compassion and empathy.
  4. Effectively work with an office team in relation to patient care and being able to take the initiative to ask for or suggest work for themselves and to complete that work with minimal supervision.
  5. Accept directions, instructions, and feedback given by supervisors or other office personnel as appropriate and follow through to make adjustments in behaviors or studies.
  6. Ask appropriate questions when in doubt about a procedure or policy, write down the information and study for the next encounter. 
  7. Act and speak in a professional manner using proper grammar, tone of voice, and use of proper terminology.

Externship/Observation Expectations:

  1. Professional Appearance
    1. Clothing/Uniform:
      1. Wear required school uniform
      2. Wear white lab jacket (must be worn in clinical office) *DENTAL STUDENTS*
      3. Wear clean closed toe shoes
    2. Jewelry should be limited to one ring per hand, and no more than 2 discreet (pierced) earrings per ear.  No dangle or large hoop earrings. No visible facial/body piercings of any kind.  Students who have stretched earlobes should wear “flesh” colored jewelry. 
    3. Hair is to be clean, short or pulled back. Hair color should be within the natural color range (blondes, browns, blacks, gray). No large hair accessories (bandannas and scarves). Sideburns, mustaches and/or beards are to be clean, short and neat.
    4. If you wear make-up it should be light day wear make-up. Short nail length with clear polish only. Keep nails well groomed and hands well moisturized to avoid cracking.
    5. Tattoos must be covered by make-up or clothing.
    6. Shower or bathe each morning before going to the office and shampoo hair often. Apply deodorant, antiperspirant or body powder daily. If foot odor is a problem, use a foot powder deodorant or sole inserts. Wash hands after contact with each patient, before contact with the patient, after you use the restroom, after working in a laboratory area or office (even though you wear gloves to do procedures). Launder uniforms after each wear. Use color safe bleach or water softeners to keep color crisp. Socks should always be worn and shoes clean.
  2. Be responsible about attendance and punctuality. Set up hours and keep them. The student is required to call the externship/observation site and instructor prior to any absence or tardiness. A doctor’s note is required for any absence. The student must make arrangements with the site to make up the time missed.
  3. Maintain OSHA Standards for Safety
    1. Use universal standards when handling all body fluids, used instruments, bandages and body tissues or participating in procedures which may be a potential source of infection to the student or other patients.
    2. Always wear gloves, appropriate eye protection or impervious gowns, and/or masks and properly dispose of equipment and other products in sharps containers, or special containers when performing any procedures in which there is a risk of spreading infection.
    3. If an exposure occurs, rinse with water and/or wash immediately with anti-microbial soap. Report the incident to your supervisor. They will administer first aid and advise you how to proceed.  Also, report the incident to your instructor as soon as possible. Proceed to obtain the necessary medical treatment or testing as advised. TMIKY or the externship/observation site are not responsible for any self-inflicted injuries.
    4. Handle biohazardous materials and chemicals with care using precautions and warnings labeled on containers and explained in the office procedural manuals for these materials. If exposed, follow the instructions posted in the office for specific material. Read beforehand. 
    5. NOTE: Students are not considered employees and are responsible for all of their own medical expenses.
  4. Perform only those procedures ordered by the provider for which the student has been instructed either in class or by the office staff and that is within the scope of your program.
  5. Keep the legal and ethical code of confidentiality of patient information and provider’s business information as taught. Breach of this ethic may be the reason for immediate withdrawal of the student from externship/observation as well as a potential for legal action.  Because of the federal guidelines for release of information (HIPAA) students are required to sign confidentiality agreements and complete HIPAA training prior to externship.
  6. Represent TMIKY’s Program’s to the community by setting a professional example. 
  7. Use of tobacco, alcohol, or mood/performance altering drug products is prohibited during externship/observation. Smelling of smoke may offend or cause respiratory reactions in co-workers and patients. Students suspected of being under the influence of alcohol or mood/performance altering drugs may be asked to take a drug test at their own expense and/ or be dismissed from externship.
  8. Use of perfume is not recommended during externship/observation due to many patients suffering from allergies. Many healthcare facilities are becoming perfume free environments. If you must use a scent, use it sparingly.
  9. Externship/observation is an extension of training and students are still considered TMIKY students. A student will not be considered a graduate until successful completion of externship/observation and ALL documentation is turned into their instructor.

Externship/Observation Guidelines:

  1. Upload weekly time sheets to their instructor, via Canvas extern/observation course.
  2. Students will be assisted in placement of an externship/observation facility chosen by their instructor to assure necessary experiences. Once assigned, if the student chooses to refuse the site they then are required to find their own. 
  3. The school cannot guarantee a particular office for externship/observation, nor will we guarantee a specific geographic location. Expect to drive up to 100 miles one way from students physical address to the externship sites physical address.
  4. Provider’s offices and other healthcare facilities have varying office hours. Evening and weekend sites are NOT readily available and cannot be guaranteed. It is the responsibility of the student to coordinate their personal schedules (i.e. work, childcare, etc.) to be available during regular business (day) hours for their externship/observation.
  5. Negative attitudes, inappropriate behavior, non-productive criticism, inappropriate verbal confrontation, or use of unacceptable language WILL NOT BE TOLERATED. An unsatisfactory evaluation from the site preceptors, provider, or staff WILL require the student to serve an additional externship/observation period, return to school for additional training, or if deemed dangerous or illegal in nature the student may be withdrawn from the program due to this misconduct. If a student is terminated from an externship/observation, any completed externship/observation hours will be invalid and non-transferable to any externship/observation reassignment. 
  6. Students will notify their instructor if any problems are encountered during their externship/observation (i.e. personality conflicts, extensive illness, etc.). The student WILL NOT remove themselves from an externship/observation site. Any problems encountered must be reported immediately. The instructor along with the education supervisor will assess the situation and make determination of the appropriate action to be taken.
  7. Should a student fail an externship/observation  or be removed from the externship/observation site for any fault of their own (i.e. leaving a site of their own accord, being unprofessional, insubordination, cell phone use etc.), the student will have to find their own replacement site, and it may not be a site that is an active site for TMIKY.  Previous hours or skills evaluations will NOT carry over to the second site placement, and a “replacement” externship/observation guideline packet must be completed. 
  8. Students will be allowed only ONE REPEAT of externship/observation. If upon the second placement, the student does not successfully complete the externship/observation they are NOT ELIGIBLE for a third replacement. The student will have failed the program, as externship/observation completion is a  requirement.
  9. Any action on the student’s part that is not fully consistent with the above statements may warrant removal from the facility and possible termination from the program and TMIKY.
  10. While in an externship/observation you are to follow all of the site rules as well as TMIKY rules. 
  11. CELL PHONE USE IS FORBIDDEN WHILE AT AN EXTERN/OBSERVATION SITE. We uphold a zero tolerance with cell phones in ANY extern/observation site. You are at the site to continue the learning process, volunteer to help if you have no assigned tasks (filing, cleaning, stocking etc.) Any activity on your cell phone (texts, calls, Facebook, etc.) is not only unprofessional and rude it could, depending on where you are in the office, result in a HIPAA violation and/or termination from the site. We suggest leaving your cell phone in your car if you may be tempted to access it. If an emergency arises, you may be contacted through the site, but ONLY for an emergency.

Evaluation Criteria/Grading:

The grade for externship/observation is based upon the successful completion of the required 40 hours. 


Students must complete the following in order to be considered a graduate: 

  • Successfully complete all Canvas assignments with a 70% or higher.
  • Successfully complete 40 hours of externship/observation
  • Supply proof they are current with their school financials

After all the above requirements have been met, the student will then be scheduled for an exit interview with the admissions department 10 days from graduation date or the day all requirements are met within their allotted 6 months. 

Statement of Acknowledgement of Externship Agreement:

I have read the syllabus/guidelines for externship including the course performance objectives and understand my responsibilities as a student. I fully accept the conditions of externship and agree to adhere to all policies set forth. I further understand that failure on my part to comply with these policies may result in failure of the externship portion of my academic program and/or forfeiture of my program certificate. I was given the opportunity to ask questions and those questions have been fully explained. I agree to make every effort to successfully complete these objectives and abide by the guidelines for conduct, skills, dress code and professionalism.

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Signature Certificate
Document name: Course Completion
lock iconUnique Document ID: cb629fcf245d9246365c9f3ff791d465512d68e3
Timestamp Audit
July 27, 2022 9:35 am EDTCourse Completion Uploaded by Cassie Black - [email protected] IP
July 27, 2022 9:45 am EDTCCT Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: