2025 Multi Medical Assistant Scholarship Application Form

2025 Multi Medical Assistant Scholarship Application Form

Thank you for your Interest in CMTC! We only accept 10 partial scholarships per cohort, so please apply as soon as possible. This is a need based Partial Scholarship.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Mobile Phone Number
Home Phone Number
E-mail*
Enter E-mail Here
Address*

Street Address

Apt/Unit #

CityState

Zip Code
Professional Reference Name*
Professional Reference Phone Number*
Must be a valid Phone Number
Personal Reference Name*
Personal Reference Phone Number*
Education (Name of School)
Have you ever been convicted of a felon?*

YesNo
Are you a citizen of the United States?*

YesNo
Why do you deserve this scholarship?*
Description of Financial Need*

0/600
PLEASE NOTE AND ACKNOWLEDGE THE FOLLOWING*

I acknowledge that if chosen for this scholarship I know that I will need to pay for all testing fees associated with this course to include Phlebotomy, Medical Assisting and EKG Technician.I acknowledge that once submitting this partial scholarship and If awarded I will adhere to all tuition due dates and policies regarding the remainder of my tuition balance.
Please note that by submitting this application you understand that if approved you must apply for your classes as soon as possible to accept your partial scholarship. If approved your scholsrahip will be credited to your account within 48-72 hours. Please make sure all information on this form is true and accurate.

Thank you from the Core Team!
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