School of Medical Technology/Medical Laboratory Science
Department of Laboratory Services

APPLICATION FOR ADMISSION

Please complete all fields below:

* Name (Last, First, Middle):
Maiden Name if applicable:
* School presently attending or graduated from:
* Applying for upcoming the class beginning on or about July 9, 2012:
YES NO
* Email Address
* School Address:
* School Phone:
* Cell Phone:
* High School Rank: Out Of (total number of students)
* SAT Scores: Math Verbal
* Home Address:
* Home Phone:
* Citizenship:
* English Language: Good Excellent
* In case of an accident, please notify (include name, address, phone, relationship):
List below all post-secondary education beyond the high school level:
DatesName and Address of SchoolMajorDegree or Diploma
From
To
      
FINAL ACCEPTANCE INTO THE PROGRAM IS CONTINGENT UPON THE APPLICANT INTERVIEW, SUCCESSFUL COMPLETION OF THE JUNIOR YEAR OF COLLEGE, WHERE APPLICABLE, AN ACCEPTABLE TRANSCRIPT EVALUATION AND THE FINDINGS OF A COMPLETE PHYSICAL EXAMINATION AS PERFORMED BY A PHYSICIAN WITH HEALTH FORCE AT THE ALTOONA REGIONAL HEALTH SYSTEM.

THE ALTOONA REGIONAL HEALTH SYSTEM SCHOOL OF MEDICAL TECHNOLOGY/MEDICAL LABORATORY SCIENCE DOES NOT DISCRIMINATE IN IT ADMISSION POLICIES WITH REGARD TO RACE, RELIGION, SEX, AGE, ETHHNIC ORGIN OR QUALIFIED HANDICAP.

Consumer Information Disclosure

In December 1989, federal regulations were instituted that require all post-secondary institutions to provide all incoming students consumer information reflecting graduation, placement rates and licensure information in the career program being pursued by the student.

In an effort to comply with these regulations, the Altoona Regional Health System School of Medical Technology/Medical Laboratory Science is providing the following information based on its most recent graduate follow-up statistics.

Four of the four students admitted to the program in 2009 went on to graduate in 2010. One hundred percent of the students were employed in their profession.

I have read and understood the graduation rate, employment rate and certification information pertinent to the program.

YES NO

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