Fall - School of Health Sciences Program Petition Request

Healthcare Pathway Program Petition Request

Petition Window Spring 2025

(Decisions come out 30 business days after the close of the petition window)

***Please Read Below***

The Petition Process is the process that students follow to inform the Healthcare Pathway when they are ready and prepared to begin the core technical courses in their chosen healthcare pathway program. All students must petition and be accepted into their program before registering for core technical courses.

After submitting this form you will receive a confirmation email of your submission, please save confirmation for your records.

Last Name

First Name

Middle Initial

MATC Student ID #

MATC Gmail Address

Phone Number

Address

City

State

Zip Code

Select the degree level you are petitioning for.

Please only select one program

Associate Degree

Technical Diploma

I have met all requirements to petition for the program.

Yes (Complete the form and submit)

I have submitted official transcripts from other colleges and the courses have been transferred to my MATC record.

Yes

None to Submit

By typing my name in the box below, I certify that all information submitted pertaining to this petition request is true.

* Indicates required items

Are you a veteran?

Yes

I have taken the prequalifying exam required for my program.
If you are transferring in a TEAS score you can find information at matchealth.com

Yes (*Fill in the score in the line)

Not required for my program: HSM, HIT, HUC, MA, Coding

If you answered Yes above, what was your score on the test.

Do you live:

In-District

Don't Know

Out of District

Prior Healthcare Experience

Job Title

Employer:

Start Date:

End Date:

Supervisor's Name

Supervisor's Email

Supervisor's Phone Number

MATC is accredited by the Higher Learning Commission, Commission on Institutions of Higher Education, the national standard in accrediting colleges and schools for distinction in academics and student services. MATC is an Affirmative Action/Equal Opportunity institution and complies with all requirements of the Americans with Disabilities Act.

Student signature

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