Medical Laboratory Technician Program Application
Upon completion of all documents and interview, the selected applicants for the program are notified by email of admission or conditional admission for the August or January entry date. The remaining applicants may be referred for career counseling. Acceptance is limited by readiness to enter the program, therefore students are selected based on the following criteria; a) applicants interview b) academic credentials c) cooperative lab support d) general education course completion including Phlebotomy national certification eligibility e) references as solicited by applicant. Please answer ALL questions.
First Name *
Your answer
Last Name *
Your answer
Barton Student ID # *
Your answer
Contact Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Daytime Phone Number *
Your answer
Can you receive texts? *
Comment on your Educational Strengths and Weaknesses *
Your answer
Why do you want to be a Medical Laboratory Technician? *
Your answer
Write a Paragraph or two with examples, evaluating yourself on the following qualities: *
Please include examples of willingness to accept responsibility, honesty, maturity, adaptability, manual dexterity and overall health. Please be able to provide examples.
Your answer
What are your long term career goals? *
Your answer
Identify your personal (strengths and weaknesses)? *
Your answer
Reference Information - 1 *
Please include business name, supervisor name, phone number, email and date of employment.
Your answer
Reference Information - 2 *
Please include business name, supervisor name, phone number, email and date of employment.
Your answer
Reference Information - 3 *
Please include business name, supervisor name, phone number, email and date of employment.
Your answer
Waiver *
WAIVER * I hereby waive the right to request a copy of completed reference forms from my student MLT file. I do this with the understanding that confidential reference statements are more readily acceptable by prospective evaluators. I understand that these documents would otherwise be available to me through my rights as expressed in the Family Education Rights and Privacy Act of 1974.
Required
Electronic Signature *
Please type your name below verifying your electronic signature.
Your answer
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