Medical Assisting Technology Application

MAT Program Application

Please read carefully before applying.

Students who are currently not a student at NW-SCC must apply and be admitted to the college in order to enter the MAT program.
Students must have all developmental courses completed to be considered for admission to the MAT program.
If on Financial Aid, you must have completed all required paperwork before applying for this program.

Please select the program for which you are applying:*

Five Semester AAS Degree Program

Certificate - Billing/Coding (21 Credit Hours)

Certificate - Phlebotomy (10 Credit Hours)

First Name*

Middle Name

Last Name*

Student # or Last 4 Digits of SSN*

Present Address

City

State

Zip

Email Address*

Cell Number*

Home Phone

Emergency Contact

Name

Relationship

Phone #

Previous Education (High School and/or College)

School

City/State

Diploma/Degree

Date

Previous medically-related work experience

I wish to enter NW-SCC's MAT program in the following semester:

Fall

Spring

I will be pursuing program requirements as a:

Full-time Student

Part-time Student

GPA (Record most recent cumulative GPA. Enter high school GPA if no college course work.)

Please attach unofficial copies of all transcripts depicting college course work.

Transcript 1

Transcript 2

Transcript 3

Signature

By checking the box to the right, I certify that all information included on this application is complete and accurate.

Programs of Study