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Medical Laboratory Science Online Application

Welcome to our online application. A complete initial application to our program includes this online application, transcripts from universities and colleges attended, and 3 required letters of recommendation. All of these application components must be received by the application deadline or your application will not be considered. See “Medical Laboratory Science Admission” for further details.

* Denotes required fields

Due to Website issues experienced in July 2019, our deadline for the submission of application materials for the class beginning in January 2020 has been extended to August 8, 2019.

School MLS Application

Contact Information

First Name

M.I.

Last Name

Present Address

City

StateExample: NY

Zip CodeExample 12345

Check here if Permanent Address is same as Present Address

Permanent Address

City

StateExample: NY

Zip Code

Primary PhoneExample: 123-123-1234 x123

Personal Information

Are you a Citizen or do you have Authorization to Work in the United States?

Yes

Have you applied to this school before?

Yes

Which starting month are you applying for?

January

June

Which starting year are you applying for?yyyy

Personal Statement

Why have you chosen a career in Medical Laboratory Science?

Employment Record 1

Company

From Date (mm/dd/yyyy)

To Date (mm/dd/yyyy)

Supervisor

Position

Company Address

City

State

Zip Code

Reason For Leaving

Employment Record 2

Company

From Date (mm/dd/yyyy)

To Date (mm/dd/yyyy)

Supervisor

Positions

Company Address

City

State

Zip Code

Reason For Leaving

Education Record 1

School/College Name

School/College Address

City

State

Zip Code

Graduation Date (mm/dd/yyyy)

Degrees

Hours of Credit

Education Record 2

School/College Name

School/College Address

City

State

Zip Code

Graduation Date (mm/dd/yyyy)

Degrees

Hours of Credit

Educational Record 3

School/College Name

School/College Address

City

State

Zip Code

Graduation Date mm/dd/yyyy

Degrees

Hours of Credit

Education Status

Will you have your Bachelor's Degree prior to entering the Medical Laboratory Science Program?

Yes

Are there any courses that do not appear on your transcript that you will be taking prior to entering the Medical Technology Program?

Yes

If yes, List those course(s) and expected completion date(s)

Additional Information

Have you ever been convicted of an offense other than a minor traffic violation?

Yes

If yes, Please describe the offense(s) and dates

Extracurricular Activities

List hobbies/interests, awards, college organizations, etc

Application Affidavit / Terms and Conditions

I understand that in order for my application file to be complete I must submit this application, official transcripts and/or evaluations from the colleges and universities I have attended, and 3 letters of recommendation. I hereby certify that all of the information listed on this form is true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection. I also understand and agree that any false, incomplete or misleading information discovered on this application at any time after I begin the Medical Technology Program may result in my dismissal. * I have read and consent to the TERMS and CONDITIONS of the application in its entirety. I further recognize that typing my name in the box below constitutes my electronic signature to this agreement

Name

Schools of Medical Science

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