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APPLICATION FOR ADMISSION
PERSONAL INFORMATION

Complete all information requested. The Surgical Technology program will communicate with the applicant via the information provided below. Please make sure all the information is accurate and up to date.

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Address(Required)
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Have you applied to this program before?(Required)
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Emergency Contact:

Please list the name and contact information of someone who will always know how to reach you.

Name:(Required)
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Max. file size: 25 MB.
Max. file size: 25 MB.
Max. file size: 25 MB.


Complete your background check by clicking https://scholar.verifiedcredentials.com/mtec, and use the code code VWFYY-83997. If you previously applied and it has been less than a year since your last application, please use code CCVJV-28489 to update your drug screen. Once complete, come back to this form to complete the application process.
I have completed Verified Credentials.(Required)
This includes a background check, drug screen and uploading all required documents.

SURGICAL TECHNOLOGY PROGRAM: SIGNATURE FORM
Consent(Required)
  • I agree that I have read and understand the Surgical Technology Program Application Requirements
  • I agree that I have read and understand the Surgical Technology Program Information
  • I agree that I have read and understand the Surgical Technology Class and Clinical Schedule, and Program Cost
  • I agree that I have read, understand, and will provide current documentation for the Application Packet Requirements
  • I agree that I have read, understand, and will provide current documentation for “Admission to the program is contingent on the following items”
  • I understand that upon acceptance into the MTECH Surgical Technology Program, all items listed in my acceptance letter are required by the due date indicated. If I fail to submit required documents by the due dates given or if I fail to attend the first week of classes, I will be dropped from the program. I may reapply for another class in another application period. I further agree that I have read and understood all of the information on this page.*


*Mountainland Technical College and the Surgical Technology Program reserve the right to make changes to the program and the application criteria at any time based on requirements from the institutional accrediting body (The Council on Occupational Education) and the Program Advisory Committee.
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