Kapi`olani Community College MEDICAL LABORATORY TECHNICIAN PROGRAM Admission Application Checklist

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1 Health Sciences Dep artment Application Period: June 1 September 1 Directions: Please complete each item carefully and submit this Admission Application Check List and all required documents to a Health Sciences Counselor during office hours at the Health Career Counseling Center in Kauila 106. Only this fully completed program Admission Application Checklist submitted to the Health Career Counseling Center (Kauila 106) by the appropriate deadline (see above) will be accepted for processing. APPLICANT INFORMATION Kapi`olani Community College MEDICAL LABORATORY TECHNICIAN PROGRAM Admission Application Checklist Name: Mailing Address: Phone: Last Name First Name M.I. UH Number/Username Street / POB City State Zip Code Cell Home Work Are you a resident of a neighbor island?: Yes No If yes, which island: Are you willing to complete your clinicals on a neighbor island?: Yes No If yes, which island: UH SYSTEM Address: List other name(s) used on documents: (Notify the KCC Kekaulike Information & Service Center regarding other names used on college documents.) ADMISSION APPLICATION CHECKLIST FOR MLT PROGRAM 1. Attend a Mandatory MLT Program Information Session. For more information visit or pick up an Information Session schedule from Kauila 122 or Kauila 106, Monday Friday from 8:00 AM to 4:00 PM. Date Attended: (Month / Day / Year) 2. Complete a UH System Application Form (New, Returning or Transfer) OR Change of Home Institution Form (Students currently enrolled at a UH System School other than KCC) Students currently enrolled at KCC do not need either of these forms. 3. Prerequisite Courses must be completed with a C grade or higher or in progress of completion by the end of the Fall semester. Completing the following program support courses is highly recommended: CHEM 162, 162L, MICRO 130, MICRO Student copy of transcripts (for course work WITHIN the UH System). UH system colleges and university transcripts are downloadable from the internet (MyUH Portal). Student copies of transcripts must be submitted with this checklist. 5. College transcripts for courses completed outside of the University of Hawai i System Official transcript(s) should be sent to the KAPCC Kekaulike Information & Service Center. Institution: Institution: Institution: Transcript Request Date: Transcript Request Date: Transcript Request Date: 5/28/15

2 Health Sciences Department 6. Request for Transcript Evaluation Form - A request for transcript evaluation must be completed for coursework outside the UH System. Completion of this form is required in order to transfer credits to KCC. This form can be obtained at the Kekaulike Information & Service Center ( Ilima 102) or online at: (see Request for Transcript Evaluation) 7. My Plan Initiative. Complete reflection essays and self assessments for your program/career pathway. 8. Self-addressed, stamped #10 (4 1/8 X 9 1/2") envelope. APPLICANT CERTIFICATIONS: I certify that the answers and responses provided for all of the items on this Admission Application Checklist are true to the best of my knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements and/or discipline measures as provided under the University s Student Conduct Code. I understand that if I am not accepted into the program of application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change my major and home institution if I am accepted into the MLT program. I understand that if I am not accepted into the MLT program, my home institution and major will not change. Health care students are required to complete University prescribed academic requirements that involve practice in a University affiliated health care facility setting with no substitution allowable for the completion required clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not satisfying academic program requirements. It is the responsibility of the student to satisfactorily complete any criminal background checks and drug testing that may be required by the affiliated health care facility to which he/she is assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated health care facility. I have read and understand the notification that a criminal background check and drug test may be required for entry into the MLT program and into clinical practice. I also understand that clinical practice is required for completion of this program. (please initial) I have completed, attached, and submitted all necessary application documents for the Medical Laboratory Technician Program by the deadline. I understand the selection is based on a basis. Print Name Signature Date EXAMPLE of how to complete the application: These are the requirements Tell us what class you took to meet each requirement Circle Points MEDICAL LABORATORY TECHNICIAN PREREQUISITES Composition I (3) OR ESL 100 Expository Writing: A Guided Approach (3) MATH 103 Fundamentals of College Algebra OR higher (3) Course Alpha Credits Term of Completion Where Completed (i.e., Institution Name) Grade Points A B C WRI Fall 2007 HPU B MATH SP 2008 KCC A /28/15

3 Health Sciences Dep artment CRITERIA FOR ACCEPTANCE: Qualification is based on a rating system of grades for completed prerequisite and support courses. Selection is based on total qualifying scores in rank order from the highest score until admission quota is met for the MLT program. MEDICAL LABORATORY TECHNICIAN PREREQUISITES Composition I (3) OR ESL 100 Expository Writing: A Guided Approach (3) MATH 103 Fundamentals of College Algebra OR higher (3) *BIOL 130 Anatomy & Physiology (4) OR Course Alpha Credits Term of Completion Where Completed (i.e., Institution Name) Grade Points *BIOL 171 General Biology 1 (3) OR *ZOOL 141 & ZOOL 142 Human Anatomy & Physiology I & II (3 & 3) *CHEM 161 General Chemistry I (3) *CHEM 161L General Chemistry I Lab (1) MLT 100 Introduction to the Clinical Laboratory** *Courses that must be completed within a 5 year time limit PROGRAM SUPPORT COURSES Total Points for Prerequisites (out of a max of 56) No points awarded *CHEM 162 General Chemistry II (3) *CHEM 162L General Chemistry II Lab (1) *MICRO 130 General Microbiology (3) *MICR 161 Immunology & Protein Chemistry (2) A. S. Social Sciences course (3) (100 level OR higher) A. S. Humanities course (3) (100 level OR higher) *Courses that must be completed within a 5 year time limit Total Points for Support Courses (out of a max of 22 ) Application Summary: For office use only Date Received: Counselor s Initials: HI Resident: Y N KaC GPA Verified: Ethnic Code: Application Complete: **Lab assistants with documented phlebotomy experience may have this requirement waived. See MLT Program Director. 5/28/15

4 Health Sciences Department Kapi`olani Community College MY PLAN Reflection Essays Name: UHID: Program: Please be clear and concise in your response for each reflective essay, limiting each question to 300 words. Career Pathway Preparation 1. In a brief statement describe your career goals in this pathway. Where do you see yourself in this career pathway in the next three years?

5 Health Sciences Dep artment Career Pathway Attributes 2. In viewing Health Careers at a Glance, what are your strongest and weakest professional qualities in your chosen career pathway? Please describe these attributes; how do you plan to overcome your challenges, how do you plan to improve on your strengths?

6 Health Sciences Dep artment Career Pathway Outlook 3. Describe any personal obstacles you face that may impact your current academic success and how you plan to overcome these challenges? (I.e. transportation, financial obligations, child care, time management). What support systems do you have in place to overcome them?

7 Health Sciences Department Kapi`olani Community College MY PLAN Self - Assessment The purpose of the self-assessment is to discover your strengths and areas of focus. Working in healthcare requires a combination of academic skills, social skills, and a commitment to public service. As you plan, find ways to make your strengths shine and to improve your weaker areas. Consider discussing your selfassessment and reflective essays with a counselor to understanding how they support your academic and career goals. Academic Strength Below Meets Exceeds Cumulative GPA Prerequisite Course GPA Completed prerequisites Completed support courses Writing ability Letters of evaluation Awards/Achievements Knowledge of the Profession Below Meets Exceeds Relevant experience volunteer Relevant experience for credit Relevant experience paid Relevant Public service/service Learning Understanding of current healthcare issues Comfort with bodily fluids Comfort with illness Comfort with injury Comfort with death Comfort with physical contact with people Ability to multitask and adapt to change Personal Characteristics Below Meets Exceeds Commitment to public service Empathy/altruism Moral/ethical integrity Emotional maturity Responsibility Leadership Dedication/hard-working Commitment to life-long learning Ability to work as a team Personal interests & experience

8 HEALTH CAREERS COUNSELING CENTER HEALTH A GLANCE FOR NURSING UPDATED: 05/2014 All programs give priority seating to qualified Hawai`i state residents. Each student should develop a My Plan with the Health Sciences/Nursing Counselor(s) for their intended program/career pathway. Program Dental Assisting (DENT) Emergency Medical Technician (EMT) Health Services Occupational Cluster Dental Direct Patient Care Professional Qualities Professional Attitude Time Management Compassion Flexibility Adapt to Changes Ability to Multitask Empathy Self Motivation Appearance & Hygiene Self Confidence Time Management Teamwork & Diplomacy Respect Patient Advocacy Starting Semester Application Period Fall Dec 1 - June 30 Fall Spring June 1 - Oct 1 Dec 1 - Apr 1 Selection Process Selection Criteria Prerequisites Prerequisites, Supplemental Application Requirements, & Interview Qualifying Placement Tests COMPASS MATH 24 or higher or evidence of completion English 100 Math 100 (or higher) English 100 Health 125 Prerequisites SP 151 ZOOL 141,141L Support Courses Required to Apply Degree (Credits) CA:39 CC:13 Health Informatics (HI) Health Information Fall Dec 1 Apr 30 First Qualified, Qualifying Scores/ Courses COMPASS ENG 22 or higher & COMPASS MATH 24 or higher, or evidence of completion of both CC:30 AS: 71 Medical Assisting (MEDA) Medical Laboratory Technician (MLT) Mobile Intensive Care Technician (MICT) Patient Care, Health Info & Diagnostic Diagnostic Laboratory Direct Patient Care Compassion Attention to Detail Ability to Multitask, Organizational Skills, Good Verbal & Written Adaptability & Flexibility Attention To Detail Dependability Good Verbal & Written Self-Starter Ability To Multi-Task Empathy Self Motivation Appearance & Hygiene Self Confidence Time Management Critical Thinking * Problem Solving Skills Teamwork & Diplomacy Respect Patient Advocacy Fall Dec 1 Mar 1 Spring June 1 Sept 1 Spring June 1 Oct 1 (every other year) Qualifying Scores/ Courses Prerequisites & Support Courses Prerequisites, Supplemental Application Requirements, & Interview COMPASS ENG 22 or higher & COMPASS MATH 24 or higher, or evidence of completion of both or ESL 100; MATH 103 or higher; BIOL 130 or BIOL 171 or ZOOL 141 & ZOOL 142; CHEM 161 & 161L; MLT 100 HLTH 125 BIOL L Recommended: CHEM L MICR 130 MICR 161 AS SS AS AH CC:33 AS:64 AS:70-73 CC:44 AS:69 Information is subject to change without notice. UPDATED: FALL 2015

9 HEALTH CAREERS COUNSELING CENTER HEALTH A GLANCE FOR NURSING UPDATED: 5/2015 All programs give priority seating to qualified Hawai`i state residents. Each student should develop a My Plan with the Health Sciences/Nursing Counselor(s) for your intended program/career pathway. Program Health Services Occupational Cluster Personal Qualities Starting Semester Application Period Selection Process Selection Criteria Qualifying Placement Tests Prerequisites Support Courses Required to Apply Degree (Credits) Occupational Therapy Assistant (OTA) Physical Therapist Assistant (PTA) Radiologic Technician (RAD) Respiratory Care Practitioner (RESPI) Rehabilitation Rehabilitation Diagnostic Imaging Direct Patient Care Able to Related & Engage With People,; people person Self Motivated & Responsible Organizational Skills Commit To Rigorous Study Critical Thinking Skills Creative & Adaptability Teamwork Skills Accountability Altruism Compassion and Caring Culture Competence Duty Social Responsibility Communication Problem Solving Compassion Hand-Eye Coordination and Visualization Acute Problem Solving Skills/ Ability to Adapt Function Under Pressure Good Work Ethic Compassion and Caring Culture Competence Ability to Adapt Ability to Multitask Organizational Skills Problem Solving Skills Teamwork & Diplomacy Good Work Ethic Fall Dec 1 May 30 Fall Apr 1 May 25 Fall Apr 1 May 31 Fall Dec 1 May 30 First Qualified, Qualifying Scores/ Courses Prerequisites & Observation Reference Score Prerequisites & Support Courses, & A 2 Exam Prerequisites, Interview, Essay, & Evidence of Degree Earned COMPASS ENG 100, & COMPASS MATH 24 or higher, or evidence of completion of both HESI A 2 Exam MATH 103 or higher HLTH 120 SP 181 ZOOL 141,141L,142,+142L MATH 135 or higher HLTH 125 MATH 100 or higher HLTH125 or HLTH110 PSY 100 or FAMR230 CHEM 100 or higher Recommended: MATH 100 CC: 5 AS:70-72 PTA 101W FAMR 230 HLTH 125 HLTH HLTH 290L A.S. Humanities Course AS:72 BIOL L or ZO- OL141,141L,142,+142L ZO- OL141,141L,142,+142L MICR 130 or MICR 135 MICR 140 A.S. Humanities Course AS/AH AS/SS AS:89-92 AS:67-68 Information is subject to change without notice.