MAT Customer Service Help Request
Search Articles
Search Articles
1 error prohibited this ticket from being saved
There were problems with the following fields:
Email Address
Subject
First and Last Name:
Please select what type of issue or question you have from this dropdown menu:
...
Register Me for the MAT Seizure Rescue Nasal Spray Online Course
I created a new account on the MAT Online Learning Center. Please manually confirm my account.
I have forgotten my username or password
All other issues or questions
I completed my in-person training and need my certificate
For Administrators ONLY - Request New Account
For MAT Trainers ONLY – ADD PROGRAM
Temp
<div class="control-group ticket_section"> <div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_website1_57674]" type="hidden" value="0" autocomplete="off" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_website1_57674_4001273905" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_website1_57674]" /> Click here if you are trying to access the MAT Online Learning Center (mat-elearning.medhomeplus.org) </label> </div> </div> <div class="control-group ticket_section"> <div class="controls"> <label class="checkbox "> <input name="helpdesk_ticket[custom_field][cf_website2_57674]" type="hidden" value="0" autocomplete="off" /><input class=" checkbox section_field" id="helpdesk_ticket_custom_field_cf_website2_57674_4001273905" type="checkbox" value="1" name="helpdesk_ticket[custom_field][cf_website2_57674]" /> Click here if you are trying to access View My Certificate Report on the MAT Program Website (mat.medhomeplus.org) </label> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_otherdesc_57674-label " for="helpdesk_ticket_cf_otherdesc_57674">Please type your issue or question in the box:</label> <div class="controls "> <textarea class=" required paragraph section_field span12" rows="6" placeholder="" name="helpdesk_ticket[custom_field][cf_otherdesc_57674]" id="helpdesk_ticket_custom_field_cf_otherdesc_57674"> </textarea> </div> </div>
<div class="control-group ticket_section"> <label class=" required control-label cf_ocdate2_57674-label " for="helpdesk_ticket_cf_ocdate2_57674">Date of Training: </label> <div class="controls "> <textarea class=" required paragraph section_field span12" rows="6" placeholder="" name="helpdesk_ticket[custom_field][cf_ocdate2_57674]" id="helpdesk_ticket_custom_field_cf_ocdate2_57674"> </textarea> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_name_of_mat_trainer_57674-label " for="helpdesk_ticket_cf_name_of_mat_trainer_57674">Name of MAT Trainer</label> <div class="controls "> <textarea class=" required paragraph section_field span12" rows="6" placeholder="" name="helpdesk_ticket[custom_field][cf_name_of_mat_trainer_57674]" id="helpdesk_ticket_custom_field_cf_name_of_mat_trainer_57674"> </textarea> </div> </div>
<div class="control-group ticket_section"> <div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_cdpaverif_57674]" id="helpdesk_ticket_custom_field_cf_cdpaverif_57674_4001382267" value="1" class=" required checkbox section_field" /> I understand that the MAT Program Office will verify my title and employment status before creating an adminsitrator account. </label> </div> </div> <div class="control-group ticket_section"> <div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_cdpaemailc_57674]" id="helpdesk_ticket_custom_field_cf_cdpaemailc_57674_4001382267" value="1" class=" required checkbox section_field" /> I understand that I must provide my individual, employer-issued email address AND my direct work phone number. </label> </div> </div> <div class="control-group ticket_section"> <div class="controls"> <label class="checkbox required"> <input type="checkbox" name="helpdesk_ticket[custom_field][cf_cdpachangec_57674]" id="helpdesk_ticket_custom_field_cf_cdpachangec_57674_4001382267" value="1" class=" required checkbox section_field" /> I understand that I must notify the MAT Program Office if the Program Administrator information changes. </label> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_cdpaindemail_57674-label " for="helpdesk_ticket_cf_cdpaindemail_57674">Individual, employer-issued email address:</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_cdpaindemail_57674]" id="helpdesk_ticket_custom_field_cf_cdpaindemail_57674" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_cdpname_57674-label " for="helpdesk_ticket_cf_cdpname_57674">Program Name:</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_cdpname_57674]" id="helpdesk_ticket_custom_field_cf_cdpname_57674" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_cdpaddr_57674-label " for="helpdesk_ticket_cf_cdpaddr_57674">Program Address:</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_cdpaddr_57674]" id="helpdesk_ticket_custom_field_cf_cdpaddr_57674" /> </div> </div> <div class="control-group ticket_section"> <label class=" required control-label cf_cdpcity_57674-label " for="helpdesk_ticket_cf_cdpcity_57674">Program City:</label> <div class="controls "> <input class=" required text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_cdpcity_57674]" id="helpdesk_ticket_custom_field_cf_cdpcity_57674" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_progname_57674-label " for="helpdesk_ticket_cf_progname_57674">Program Name:</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_progname_57674]" id="helpdesk_ticket_custom_field_cf_progname_57674" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_progaddr_57674-label " for="helpdesk_ticket_cf_progaddr_57674">Program Address:</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_progaddr_57674]" id="helpdesk_ticket_custom_field_cf_progaddr_57674" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_progcity_57674-label " for="helpdesk_ticket_cf_progcity_57674">Program City:</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_progcity_57674]" id="helpdesk_ticket_custom_field_cf_progcity_57674" /> </div> </div>
Please enter your phone number, in case we need to contact you about your request.
CAPTCHA verification is required.
Search our knowledge base
or Browse articles