Fillable HEALTH SCIENCES WAIVER REQUEST PROGRAM DECLARATION (Midlands Technical College)

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HEALTH SCIENCES WAIVER REQUEST PROGRAM DECLARATION (Midlands Technical College)

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The HEALTH SCIENCES WAIVER REQUEST PROGRAM DECLARATION (Midlands Technical College) form is 1 page long and contains:

  • 3 signatures
  • 2 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

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SECTION 1 TO BE COMPLETED BY STUDENT
Request waiver of the program admission requirement(s) indicated: (Health Sciences Program)
TEAS-V or SAT or ACT ASSET
Other Please Specify
If this waiver is approved, request that I be admitted to the Pre-Health Care Certificate (PTH6 for Physical Therapist Assistant
program. I understand that program changes may aect my financial aid and financial aid counseling is available at the
Financial Aid Oce on either Beltline or Airport campus.
Please Print Name
Signature
Date Social Security Number
A F
SECTION 2 TO BE COMPLETED BY PROGRAM DIRECTOR
o
Approved
o
Disapproved
Comments:
Signature Date
SECTION 3 TO BE COMPLETED BY AHNAC
To: MTC Records Oce
Please add the following program codes to this student’s record. (This action is not intended to delete or change any previous
program codes.)
Major Minor
AHNAC Signature Dates
midlandstech.edu
i
PO Box 2408
i
Columbia, SC 29202
i
803.738.8324
OFFICE OF ADMISSIONS
HEALTH SCIENCES WAIVER
REQUEST PROGRAM DECLARATION
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HEALTH SCIENCES WAIVER REQUEST PROGRAM DECLARATION (Midlands Technical College)

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Completed 4 February 2021

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