Medical Office Technology Application

Tuesday, April 29, 2025

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This application is for students who have completed an application to UA - Pulaski Tech. If you have any questions about this form or about the Medical Office Technology (MOT) program, please contact bdmiller@uaptc.edu.

Full Name:

Student ID or Social Security Number:

Date of Birth:

Address:

City:

State:

Zip Code:

Phone:

Email:

Student Type:

Full-Time

Part-Time

Applying for:

Spring

Fall

Summer Extended

Choose program:

Technical Certificate in Medical Office Technology

Certificate of Proficiency in Medical Office Technology

PLEASE SUBMIT THIS APPLICATION ONCE.

About Health Information Technology
HIT Application Procedures
HIT Application
Frequently Asked Questions
Medical Office Technology
Medical Office Technology Application
Contact Information