MEDICAL LABORATORY TECHNOLOGY PROGRAM APPLICATION PACKET

Health Sciences Division MEDICAL LABORATORY TECHNOLOGY PROGRAM APPLICATION PACKET University System of Georgia An Affirmative Action/Equal Opportunity Institution Revised 06/2014

Medical Laboratory Technology Histotechnology 2400 Gillionville Road Albany, Georgia 31707 Phone: (229) 317-6846 Fax: (229) 317-6682 Dear Prospective Student, Thank you for your interest in the Darton State College Medical Laboratory Technology Program. Included in this packet is an application for entrance into the Medical Laboratory Technology Program as well as additional information about the program. Program information, an application packet and an online application option is also available from the program homepage http://www.darton.edu/programs/alliedhealth/mlt/ If I can further assist you, please contact me at 229-317-6846 or by email at nancy.beamon@darton.edu Sincerely, Nancy Beamon Nancy Beamon, Director, MLT/HT Darton State College

DARTON STATE COLLEGE MEDICAL LABORATORY TECHNOLOGY MISSION STATEMENT The Medical Laboratory Technology (MLT) program supports the Health Sciences Division of Darton State College in its goal of becoming the Health Sciences Educational Center for southwest Georgia. The mission of the Medical Laboratory Technology program is to provide educational opportunities and related services to qualified students pursuing an entry-level career as a registered Medical Laboratory Technician. Upon successful completion of the program the students will earn an Associate of Science Degree and will be academically eligible for national board examinations. Beneficiaries of the program include the students, the college, the community, the profession, and other health care providers. Program stability and viability will be ensured through a process of continuous quality assessment and improvement. PROGRAM DESCRIPTION Darton State College, accredited by the Southern Association of Colleges and Schools, is a part of the University System of Georgia. The Medical Laboratory Technology Program, initiated in 1974, is part of the Division of Health Sciences. The National Accrediting Agency for Clinical Laboratory Sciences (*NAACLS) accredits the program. The first class graduated in 1976 and the program has remained in continuous operation since. The curriculum is based on the Essentials and Guidelines of Accredited Educational Programs for Medical Laboratory Technicians. This career program consists of four semesters of study, with the final semester spent in clinical externship. Each student is assigned to one, or a combination of several, current affiliate(s). One or more accrediting agencies accredit each clinical affiliate. Darton State College awards students who successfully complete the requirements of the MLT program with an Associate of Science Degree. Graduates are eligible to take national board examinations. The Darton State College MLT Program is currently the largest MLT Program in the state of Georgia and offers both traditional classes and a distance learning option. *The address, phone number and fax number for NAACLS is as follows: National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) 5600 N. River Road Suite 720 Rosemont, Illinois 60018; PH:(773) 714-8880 ; FAX :(773) 714-8886

Rev 09/10/13 Courses required Semester Hours Pre-requisites BIOL 1100k or (BIOL 2111k & BIOL 2112k) ENGL 1101 MATH 1111 Human Anatomy & Physiology for the Healthcare Professional English Composition I College Algebra 4 3 3 Total 10 Freshman Year Fall Semester ENGL 1102 English Composition I * 3 CHEM 1211K Principles of Chemistry I* 4 BIOL 2115k Essentials of Microbiology 4 MLTS 1160 W Medical Laboratory Technology I* 3 MLTS 1160L Medical Laboratory Technology I (Lab)* 1 15 Spring Semester CHEM 1212K Principles of Chemistry II* 4 Elective Humanities and Fine Arts Elective* 3 MLTS 1161W Medical Laboratory Technology II * 3 MLTS 1161L Medical Laboratory Technology II* (Lab) 1 MLTS 1182 Medical Parasitology, Mycology, Virology* 3 14 Sophomore Year Semester Hours Summer Semester COMM1110 Public Speaking* 3 POLS 1101 Political Science* 3 MLTS 2010W Medical Laboratory Technology III * 2 MLTS 2010L Medical Laboratory Technology III* (Lab) 2 MLTS 2020W Medical Laboratory Technology IV * 3 MLTS 2020L Medical Laboratory Technology IV * (Lab) 1 14 Fall Semester MLTS 2630 Externship* 15 MLTS 2067 Seminars * 1 17 * Online options Two Year Total 70

Alternate vs Full Status All eligible students, who complete the application process are permitted to participate in program courses. On campus students will receive one of two designations. 10-12 students will be accepted on the Darton State College Campus with Full Status and all others will be classified as Alternate Status. Both groups are allowed to take program courses on campus but only Full Status students are guaranteed clinical placement in the fourth semester (Fall). Alternate Status students who complete the program requirements will receive clinical placements after the Full Status students as space become available. The Full Status student designations are based on the highest GPA at the time of consideration. Students wishing to participate fully online must have the support of a hospital willing to affiliate with our program. Affiliation allows student access to the hospital facility, resources and supervision. Required General Education Courses Most are available on line Transfer credit from an accredited school of a C or better is generally accepted. MLT Professional Courses Didactic Content Component Traditional classroom option On-line option. Student Labs Fall and spring semester student laboratory exercises are offered on campus once per week in 3-hour lab sessions. Summer semester, labs meet more frequently and are usually scheduled on Monday, Tuesday and Wednesdays. Alternative Student Lab Locations 1. Georgia Highlands College ( Rome, GA) 2. Hospital Affiliate Laboratory (An agreement would have to be established with a facility in your area willing to allow you to perform student lab exercises in their lab facility). This option is usually only available to students with a working relationship with a clinical lab. Enrollment Requirements Detailed in the Darton State College Catalog. Summary: You must meet Darton State College enrollment requirements. You must have a SAT score of 870 or 9 semester hours of related courses at DC with a GPA of 2.5. You must complete any learning support requirements prior to enrollment in MLT professional courses. Transfer students must have a GPA of 2.5 or greater or 9 semester hours of related courses at DC with a GPA of 2.5. Students with a degree from an accredited college or university may enroll in individual MLT courses with the program director s permission, provided prerequisites are met.

You must have visual acuity, physical ability and manual dexterity sufficient to perform required procedures and activities of the program. (A physical Evaluation Form from a healthcare provider is required) Students must provide proof of health insurance coverage prior to starting the Professional Program MLTS courses. It is a Board of Regents requirement that students carry personal health insurance, or purchase student insurance. This requirement is mandatory. Students must maintain a C or better in all professional courses. Program Most students begin the MLT curriculum Fall Semester and will complete the program fall semester in December of the next year. The program is a four semester program (fall, spring, summer and fall) and students are expected to complete the program courses as indicated by the curriculum guide. Failure to complete courses as indicated in the curriculum guide may result in a student s dismissal from the program. Such students may reapply for admission consideration the following year and would be required to retake program courses or demonstrate current course competency by written and/or practical exam. Students can only repeat a single MLT course in which they are unsuccessful ( < C grade). Students with two unsuccessful attempts in program courses are ineligible for program readmission. Withdrawing from a MLTS course is considered an unsuccessful attempt. A course grade of D or F is considered an unsuccessful attempt. Students wishing to web register must complete a web registration waiver form and submit to their advisor a curriculum plan. Web release tutorial: https://dcs.darton.edu/wrt/ Waiver info and form: https://srtn.darton.edu/forms/online_forms/disclaimer.html Curriculum Plan: Follows (return to me for your file) If you are on financial aid, be sure to plan each semester s course work with sufficient credits to meet requirements. The final fall semester students participate in a clinical externship and a seminar course (19 credit hours). Students are assigned to a clinical affiliate for 36 hours per week for 16 weeks. This is day shift and generally other shifts or weekends are unavailable. During this time, students are allowed to perform laboratory procedures to gain entry level job competencies and proficiencies. Students are evaluated by exam, performance and compliance with Darton State College, Program and affiliate policies.

Student ID# DATE Medical Laboratory Technology Histotechnology 2400 Gillionville Road Albany, Georgia 31707 Phone: (229) 317-6846 Fax: (229) 317-6682 Course Plan: see curriculum guide for required courses. NOTE: The MLT Program may be completed in 4 semesters. Taking general education classes prior to starting the program may result in you being a part-time student and may impact financial aid. Prior to entry to MLT Program Course Credits Example: ENGL 111 3 MLT Program Semester 1 FALL Course Credits MLT Program Semester 2 SPRING Course Credits MLT Program Semester 3 SUMMER Course Credits MLT Program Semester 4 FALL Course Credits

Application Process 1. Students must apply to and be accepted for enrollment with Darton State College. 2. Students must complete any learning support requirements prior to Program consideration. 3. Students must submit a completed MLT Program Application to the Darton State College MLT Program Director or Education/Clinical Coordinators at Georgia Highlands College The MLT Program Application consists of HBV immunizations records, three letters of recommendation, Physical Exam Record and the MLT Program Application. Application Dead Line The following deadlines will apply: Beginning Semester Application Deadline *Fall Semester July 1 Spring Semester December 1 Summer Semester May 1 *Note: Most new students begin fall semester. Spring and Summer Semesters Program admissions based on individual review and space availability. A SAMPLE OF HOW APPLICANTS ARE EVALUATED Applicant Evaluation Applicant Requirement Alternate Applicant Minimum Acceptance Application Exit LS Completed Exit all Recommendations: 1 2 3 3 Immunization Record HBV Immunizations 3 or + titer Sat Score/gpa 870 9 semester hrs of related DC courses with >/= 2.5 Prerequisites BIOL 1100K ENGL 1101 MATH 1111 BIOL 2111K & BIOL 2112K # of courses attempted receiving a grade of W Previous lab work Physical Evaluation Personal Health Ins Status Determination : yes no Yes Yes

Darton State College Medical Laboratory Technology Application Office Use Only Student ID Sat Exit LS GPA Prerequisites(BIOL1100, ENGL1101, MATH1111) #W Recommendations:1 2 3 Previous lab work: yes no HBV Immunizations Imm Record Medical Exam Health Ins Name Date Darton State College Student ID# Current Mailing Address Street: Apt: City State Zip Phone: Home: Work: Cell: Email List colleges previously attended and degrees held. College Years Attended Degree Awarded Have you previously applied to this program? Yes No If yes, when? Have you applied to another Health Sciences Program? Yes No Is Medical Laboratory Technology your current major? Yes No Instructions: Indicate courses satisfactorily completed with a C or higher by placing a in the appropriate box. BIOL 1100K ENGL 1101 BIOL 2115K ENGL 1102 CHEM 1211 HIST 2111 or 2112 CHEM 1212 MATH 1111 COMM 1110 POLS 1101 I have read all of the attached information and understand the application and selection process. I hereby apply for admission to the Darton State College Medical Laboratory Technology Program for the Fall Semester of the year. NOTE: Please attach a copy of your current Health Insurance card, Immunization Record, Physical Evaluation Form, letters of recommendation and accreditation acknowledgement form with your application. Signature DATE:

Medical Laboratory Technology Histotechnology 2400 Gillionville Road Albany, Georgia 31707 Phone: (229) 317-6846 Fax: (229) 317-6682 Physical Evaluation Form To be completed by physician/health care provider. I have examined and find that she/he meets the following essential functions required for participation in the Darton State College Medical Laboratory Technology Program. The essentials are as follows: Visual Acuity (with or without corrective lenses) sufficient to differentiate colors used as reaction indicators; to differentiate and identify specimens utilizing microscopic examination; to read laboratory manuals, procedures, policies, specimen labels, test requisitions and other materials pertinent to professional practice; Physical Ability to manipulate clinical laboratory instruments and equipment in a manner consistent with operational procedures; Manual Dexterity to perform procedures and operate equipment consistent with operational guidelines. Physician/Health Care Provider Date

Health Science Student Acknowledgement of Accreditation Status & Employability Accreditation and Approvals: Darton State College is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools, 1866 Southern Lane, Decatur, Georgia 30033-4097, (404)679-4501 to award Associate Degrees. Specific programs of study and their accreditation or approval bodies: Cancer Registry Management Program Accredited by the National Cancer Registrars Association, Formal Education Program Review Committee, 1340 Braddock Place, Suite203, Alexandria, VA 22314. Cardiovascular Technology Program Accredited by the Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT), 1248 Harwood Road, Bedford, TX 76021. Phone (214) 206-3117 through the Committee on Accreditation of Health Science Education Programs (CAAHEP), 1361 Park Street, Clearwater, FL, 33756. Phone (727) 210-2350, Fax (727) 210-2354. Dental Hygiene Program Accredited by the Commission on Dental Accreditation, a specialized accrediting body recognized by the United States Department of Education. The Commission on Dental Accreditation can be contacted at (312)440-2568 or at 211 East Chicago Avenue, Chicago, IL 60611. Emergency Medical Services Program Accredited by the Commission on Accreditation of Educational Program for the Emergency Medical Services Professions (CoA EMSP), 3301 Lakeview Pkwy, Suite 111-312 Rowlett, TX 75088, 214-703-8445 Ext 111 Health Information Technology Program Accredited by the Commission on Accreditation for Health Informatics and Information Management Education, 233 N. Michigan Avenue, Chicago, IL 60601-5519, (312)233-1100, www.cahiim.org. This is an agency of the American Health Information Management Association (AHIMA) 233 N. Michigan Ave., Chicago, IL 60601-5519 (312)787-2672 www.ahima.org. Histotechnology Program Accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), 5600 N. River Rd., Suite 720, Rosemont, IL 60018-5119 (773) 714-8880, www.naacls.org Medical Laboratory Technology Program- Accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS), 5600 N. River Road, Suite 720, Rosemont, Ill. 60018-5119 Phone: (773) 714-8880, fax: (773) 714-8886. www.naacls.org. Occupational Therapy Assistant Program - Accredited by the Accreditation Council for Occupational Therapy Education (ACOTE), The American Occupational Therapy Association, P.O. Box 31220, Bethesda, MD 20824-1220, (301)652-2682. Physical Therapist Assistant Program - Accredited by the Commission on Accreditation in Physical Therapy Education, 1111 No. Fairfax Street, Alexandria, VA 22314, (703) 684-2782. Polysomnographic Technology Accredited by Commission on Accreditation for Polysomnographic Technologist Education, 1711 Frank Avenue, New Bern, NC 28560, (252)626-3238. Respiratory Care Program - Accredited by the Commission on Accreditation for Respiratory Care (COARC), 1248 Harwood Rd., Bedford, TX 76021 (817) 283-2835. THE FOLLOWING PROGRAMS ARE NOT ACCREDITED AT THIS TIME: Diagnostic Medical Sonography PROGRAMS THAT ARE CURRENTLY IN THE INITIAL ACCREDITATION PROCESS: Radiologic Science - Joint Review Committee on Education in Radiologic Technology (JRCERT) 20 North Wacker Drive, Suite 2850, Chicago, IL 60606-3182 (312) 704-5300 PROGRAMS THAT DO NOT HAVE SPECIFIC PROGRAM ACCREDITATION AGENCIES AT THIS TIME: Computed Tomography Medical Coding Phlebotomy As a Health Science program student at Darton State College, I hereby verify with my signature that I am aware of the accreditation or approval status of the given program that I have been accepted into. Printed Name Program Signature Date Employability Darton State College does not offer formalized job placement services or guarantee employment after graduation from any Health Science program. The employability of a Health Science program graduate is dependent on changeable job market factors and variables beyond the control of Darton State College. It is the responsibility of the graduate to secure employment after program completion. As a Health Science program student at Darton State College, I hereby verify with my signature that I understand the employability statement as written above. Printed Name Signature Date Revised May 27, 2014