Medical Laboratory Science Program. Application Procedure

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1 Application Procedure Application form 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 Morristown, NJ Application Processing Fee Submit a $ 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 discretion of the Program Director.

2 Morristown Medical Center Morristown, New Jersey Please Print Clearly: APPLICATION FOR ADMISSION 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 #: 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 yes no 1

3 Morristown Medical Center Morristown, New Jersey 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 Are you currently certified as a MLT? Yes no 2

4 Morristown Medical Center Morristown, New Jersey 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. 3

5 Morristown Medical Center Morristown, New Jersey

6 Morristown Medical Center Morristown, New Jersey 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: 5

7 Recommendation Form Section above the double line to be completed by the applicant Name of applicant has requested that this 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 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 N/A 1. Classroom performance 2. Laboratory performance 3. Verbal expression of ideas 4. Written expression of ideas 5. Emotional maturity 6. Ability to work with others 7. Ability to work independently 1

8 Please comment on the applicant s potential for success in a clinical curriculum. Include, as appropriate, the applicant s demonstrated interest in healthcare, technical and problem-solving skills, and academic achievement. Signature and title date 2

9 Essential Functions Acknowledge Statement Applicants who accept a position at Atlantic Health System, School of Medical 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. Applicant signature Date

10 Atlantic Health System - Morristown Medical Center Medical Laboratory Science Program 100 Madison Avenue Box 17 Morristown, NJ School of Medical Laboratory Science - Estimated Student Expenses Tuition $5, Textbooks $ Background Check $75.00 Uniforms $ Professional Component $ Student Membership: American Society of Clinical Laboratory Science Fall and Spring Seminars/Symposiums Case study poster A non-refundable deposit of $ 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, 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. For students paying full tuition at their school, the school s refund policy will be in effect.

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