Medical Laboratory Science Program. Application Procedure

Application Procedure

Complete the enclosed application for admission and submit it to: Drew J. Minardi, Program Director

Atlantic Health System – Morristown Medical Center School of Medical Laboratory Science

100 Madison Avenue, Box 17 Morristown, NJ 07960

Application Processing Fee

Submit a $100.00 application processing fee (money order or certified check only) payable to “Morristown Medical Center”.

Transcripts

Official transcripts of all college level course work must be submitted to the office of the Program Director. For degrees in progress, transcripts should minimally include courses completed through the sophomore year of study.

References

Three letters of recommendation are required from educators who are familiar with your academic performance. The enclosed recommendation forms are to be used by

individuals submitting references. Interview

Once the application and supporting credentials are reviewed and admission requirements are evaluated, the applicant will be contacted to schedule a personal interview. Interviews are usually scheduled during the months of November and December.

Application deadline

Applications and supporting documents should be submitted to the Program Director by November 15. Applications received after November 15 will be acted upon at the

1 APPLICATION FOR ADMISSION

Please Print Clearly:

Name: ______________________________________________________________________________

Last First Middle

Permanent address:

__________________________________________________ Street Address

___________________________________________________

City State Zip Code

Current/ School Address: (if different from home address)

____________________________________________________ Street Address

____________________________________________________

City State Zip Code

Telephone: Home ( ) ______________ Cell ( ) _________________________________ Social security #: _______________________________________________________________

Email address _________________________________________________________________

American Citizen: _________Yes _________No

If No, you must provide proof of Permanent Residency Status (J-1 Visa) to be considered for admission. Language: Is English your first language? _______yes ______no

If you answered “No” above: Have you taken the TOEFL (Test of English as a Foreign Language) ______yes ______ no

Month/ Year Taken ____________ Score _________________

Have you been convicted of any criminal violation of law, or are you now under pending investigation or charges of violation of criminal law. If yes, explain

2

EDUCATION: List the colleges/universities you have attended beginning with the current or most recent.

Institution Attended from to Credits Major Graduation date

**Please obtain official transcripts from each college/ university you have attended and submit them with the application in a sealed envelope.

**If you are taking courses to meet entrance requirements, list the classes you are currently enrolled in and /or those you plan to enroll in for the next semester.

Current Courses in Progress Planned Courses (Spring/Summer) if Applicable

EMPLOYMENT HISTORY: List the positions you have held in chronological order beginning with the current or most recent or attach a current resume to your application form.

Employer Position

Dates from to

REFERENCES: List the names and positions of three educators who have agreed to submit recommendations on your behalf.

Name Title/Position

3

Application Essay Directions:

Briefly describe your reasons for pursuing a degree or certification in clinical laboratory science. Include specific reasons for selecting this field of study and a statement of your current career goals. Please neatly print essay in no more than 250 words.

5 I certify that the information contained in this application is true. I further understand that falsification of information or incomplete statement herein will result in cancelation of this application. I agree that examination and verification of employment or previous education, except as it pertains to age, race, gender, sex, color, creed, national origin, marital status or disability, may be made and used relative to my application status. I therefore authorize investigation of all statements on this application is complete and accurate.

Applicant Signature: _____________________________________ Date: ________________

1 Section above the double line to be completed by the applicant

______________________________________ has requested that this

Name of applicant recommendation be completed as part of his/her application for the program in clinical laboratory science at the facilities of Atlantic Health.

I am aware of my right to inspect letters of recommendation under Title IV of Public Law 90-247. I  waive  do not waive my right to inspect this recommendation.

Please complete both pages of this form.

How long have you known the applicant and in what capacity?

_______________________________________________________________ _______________________________________________________________ Please evaluate the applicant in each of the areas listed below using the following scale:

3 = superior, consistently exceeds minimum requirements

2 = above average, meets and occasionally exceeds minimum requirements 1 = average, meets minimum requirements

0 = below average, unable to meet minimum requirements N/A = did not observe, unable to evaluate

3 2 1 0 N/A

1. Classroom performance 2. Laboratory performance 3. Verbal expression of ideas 4. Written expression of ideas 5. Emotional maturity

2 and problem-solving skills, and academic achievement.

__________________________________________________ _______________

Essential Functions Acknowledge Statement

Laboratory Science Program should do so with a clear understanding of the functional expectations of the program. The student must be able to fulfill these expectations in order to successfully complete this program. You are asked to read the following

essential functions and determine whether you can perform these functions to complete the program. Students of the Medical Technology Program are expected to:

 possess vision which allows the student to:

 read typewritten text from hard copy and computer monitors

 discriminate color in order to identify reagents/media, physical properties of specimens, and cells or organisms by microscopic examination.

 read, write, and communicate verbally with staff and patients in the English language

 possess manual dexterity as required in tasks such as:

 performing venipuncture

 operating delicate analytic instruments

 handling small containers of biohazardous substances (1” X1”)

 using measuring devices

 focusing and manipulation of a microscope and distinguish between primary colors

 traverse hospital and laboratory corridors, spaces, and doorways (minimum 3’ width)

 adjust to changes in environment to accommodate distractions such as moderate noise and activity in the work environment.

 travel to supplemental rotation sites for lecture and lab classes

I have read and fully comprehend the essential functions required and listed above for the completion of the Medical Laboratory Science Program.

________________________________ ___________

Morristown, NJ 07960

_________________________________________________________________

School of Medical Laboratory Science - Estimated Student Expenses

Tuition $5,500.00 Textbooks $500.00 Background Check $75.00 Uniforms $120.00 Professional Component $300.00

 Student Membership: American Society of Clinical Laboratory Science  Fall and Spring Seminars/Symposiums

 Case study poster

--- A non-refundable deposit of $500.00 is due upon confirmation acceptance. This will be credited

towards the cost of the tuition. Note: All tuition payments and deposits must be paid by money order or certified bank check. No personal checks or credit cards are accepted.

Balance of $5,000.00 paid in two installments.

 $2,500 paid 30 days prior to the start of the program.

 $2,500 paid the first day back in January after the Holiday Break.

Withdrawal and Refund Policy

Any student who wishes to withdraw from the program must submit a letter of resignation to and consult with the Program Director. The student’s college advisor will be notified of the student’s intent to withdraw. If a student voluntarily withdraws or is dismissed during the first eight weeks of the program after the tuition installment has been paid, the refund policy is as follows:

First week through fourth week: 75% refund Fifth week through the eighth week: 50% refund After eighth week – NO REFUND

The effective withdrawal date is the date on which a written statement from the student is received by the program director. If the student is dismissed, the effective date is the last day of the student's attendance in the rotation.