Marion Technical College
Petition for Receiving A Certificate

*****Must fill in all fields or the form will not submit*****

Petition Due Dates for: Deadline for students to petition for certificate: Deadline for advisors to submit approvals:
SPRING 2019 October 15 November 1
SUMMER 2019 February 1 March 1
FALL 2019 April 1 May 1

Graduating Year:  

Graduating Term:

Student ID Number: (PowerCAMPUS - required)

Telephone Number:

Birth Date:

Name: (As you want it to appear on your certificate!)


First Name


Middle Name


Last Name


Street Address


City


State


Zip code

 
County

Check here if this is a new address

I AM PETITIONING TO RECEIVE THE FOLLOWING 1 YEAR TECHNICAL CERTIFICATE.
(Please check the box next to your certificate program.)

Business/Information Technologies/Public Services:

Accounting
Addiction Studies
Business Management
Database Administration
Networking
Office Administration
Software Development
Web Development
Marion Law Enforcement Academy
 

Health:

Clinical Health Informatics Specialist
Exercise Science
Health Aide
Medical Assisting
Medical Billing and Coding
Phlebotomy
 

Engineering:

Robotics
 

Vaughn Industries:

Line Erector
Pipefitter
Sheet Metal Worker
Sub Station Electrician
Electrician
 

I hereby petition to receive a certificate from Marion Technical College.
I have completed all the above information, have met with my advisor and know I will meet all requirements for graduation at the end of the listed Term/Year above.


Signature (Type your name)

Date (MM/DD/YYYY)

Any questions direct them to the Office of Student Records email at the email address listed below.

Petitions must be completed prior to the end of the graduating term/yr.

College Registrar,
Marion Technical College
1467 Mount Vernon Avenue
Marion, OH 43302-5694
Phone:  740.389.4636
Fax:  740.389.6136
registrar@mtc.edu