Organization Profile Form

Patient Care Technician (PCT) AMT
Please note: Programs must be active and currently enrolling, instructing, or graduating students at the time organizational profile information is submitted for AMT review. AMT is unable to review or approve inactive, discontinued, or planned programs that are not yet operational.
Organization Profile
Organization Name
Campus Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Type
High School Affiliate
Name of Partnered Organization
Accreditor (check all that apply)

Other
Current certification agency used (check all that apply)

Other
Professional Website Address and/or Academic Program Links
example: www.amt-university.org
Contact Info

As indicated in your organization's course catalog
Contact Name

First NameLast Name
Title
Business Email
example@example.com
Phone Number
Format: (000) 000-0000.
Program Curriculum
Number of Classroom Clock Hours
(Convert credit hours to clock hours)
Number of Supervised Clinical Hours
(Convert credit hours to clock hours)
Length of Program
(Length of time it takes for students to complete the program)
Attach a copy of your syllabus or course outline

Cancelof
Minimum Program Requirements

Check all areas below which apply to your curriculum
Allied Health Foundations
Personal Patient Assistance and Care
Clinical Procedures
Clinical Patient Environment
Total Program Requirements Selected
Decimal of Program Requirements Selected
% of Program Requirements Selected
By submitting this form, I am attesting to the accuracy of the information provided.
Agreement
Please verify that you are human
Account Care
N/A - Accreditor
(If other)
N/A - Certification Agency Used
(If other)
N/A - The below list are skills learned in a patient care technician program. Please check the box to indicate that students gain these necessary skills in your program.
Should be Empty:

Patient Care Technician (PCT) AMT

Organization Profile

Contact Info

Program Curriculum

Minimum Program Requirements