APPLICATION INFORMATION and INSTRUCTIONS Applicatins must be cmpleted in their entirety. Incmplete applicatins may nt be cnsidered. APPLICATION PERIOD: Rlling Admissin Submit Supplemental Medical Labratry Technician Applicatin, the $25 applicatin fee and all ther required admissins dcuments t: Hward Cmmunity Cllege Office f Admissins and Advising RCF Building-242, 10901 Little Patuxent Parkway Clumbia, MD 21044 QUESTIONS: Telephne: 443-518-4230 Email: alliedhealth@hward.edu Fax: 443-518-4589 Admissins: www.hwardcc.edu/admissins CORRESPONDENCE: Crrespndence will be sent t yur HCC email accunt if yu are currently enrlled in cursewrk at Hward Cmmunity Cllege. If yu are nt currently enrlled in cursewrk at Hward Cmmunity Cllege please ensure the email address prvided n the supplemental applicatin is current and checked ften as this will be the fficial mde f cmmunicatin thrughut the applicatin prcess. ADDITIONAL ADMISSIONS REQUIREMENTS: HCC General Applicatin fr Admissin ($25 applicatin fee) with Medical Labratry Technician (#279) declared as Learning Prgram Cde Official Transcript Evaluatin Request Frm submitted fr prir learning credit (if applicable) Official academic transcripts frm each cllege/university submitted fr prir learning credit (if applicable) Prerequisite curses must be cmpleted with a grade f C r better Science GPA f 2.25 r higher Overall HCC GPA f 2.0 r higher ACCREDITATON: The Medical Labratry Technician prgram is fully accredited by NAACLS (Natinal Accrediting Agency fr Clinical Labratry Sciences), 5600 Nrth River Rad, Suite 720, Rsemnt, Illinis, 60018, phne: 773-714-8880. RESIDENCY: Applicants wh reside in Hward Cunty fr a minimum f 90 days prir t the applicatin deadline will be given pririty in the selectin prcess. Hward Cunty applicants must submit ne f the fllwing dcuments frm each f the lists belw fr a ttal f tw. The Cllege reserves the right t request additinal infrmatin and dcumentatin as necessary. Select ne frm this list: Valid Maryland driver s license MVA issued change f address card Valid state issued ID Vter s registratin card Rental agreement/deed/lease Select ne frm this list:* Utility bill: gas, electric, phne, cable, water Hward cunty tax bill Statement frm bank, credit card r insurance cmpany Pay stub with current address *Must be dated within three mnths f submitting applicatin INTERNATIONAL (F1) STUDENTS interested in applying shuld meet with an Internatinal Academic Advisr t cnfirm their eligibility. PRIOR LEARNING CREDIT: If yu expect t transfer credit, all academic cursewrk taken utside f HCC frm an accredited cllege/university shuld be evaluated by submitting fficial transcripts in sealed envelpes frm each cllege/university, the Official Transcript Evaluatin Request Frm (als available in the Office f Admissins & Advising) and a $15 prcessing fee. Academic cursewrk cmpleted utside f the United States must first be evaluated, curse-by-curse, fr transfer by a natinally accredited transcript evaluatin service accepted by HCC, (list available in the Office f Admissins & Advising) and then sent t Hward Cmmunity Cllege, Office f Admissins & Advising. Please see reverse side 1 9/8/15
APPLICATION INFORMATION and INSTRUCTIONS Cntinued ADMISSION SELECTION: Qualified students will be selected n a rlling basis. Once all seats in the class have been assigned, the remaining qualified students will be placed n a waitlist. If an accepted student declines his/her ffer f admissin r fails t meet the prvisins f their acceptance, as utlined in their letter f acceptance, the next eligible student n the waitlist will be ntified fr placement in the class. Fr thse waitlisted students wh d nt receive a seat, a new supplemental applicatin must be submitted fr the next applicatin cycle. NON-REFUNDABLE $300 DEPOSIT: If admitted, a nn-refundable $300 depsit will be required frm accepted students t hld their seat in the class and will be applied t their Spring 2016 tuitin. REQUIRED DOCUMENTATION: If admitted, Heath Frms with immunizatin and titer certificatins, and CPR Certificatin will be required in rder t ensure the safety f patients in the clinical setting. Dcumentatin is required by the designated deadline as utlined during Medical Labratry Technician New Student Orientatin and prir t ffsite clinical rtatins. COLOR BLINDNESS TEST: If admitted, accepted students will be tested fr clr blindness prir t clinical cursewrk. PLEASE NOTE: If admitted, a Drug Screening and a Criminal Backgrund Check will be required prir t enrllment in any nursing/allied health clinical curse in rder t ensure the safety f patients in the clinical setting. Students wh d nt cmply with the drug screening and criminal backgrund check are ineligible fr placement in clinical agencies and therefre are nt able t prgress in the clinical nursing/allied health prgram. Students with a criminal backgrund may be unable t prgress in the clinical nursing/allied health prgram. It is the students respnsibility t knw whether they are eligible fr licensure. If a student has a criminal backgrund, it is the students respnsibility t explre whether the backgrund will prhibit them frm being licensed and emplyed in the health care industry. HCC faculty and staff are NOT able t prvide legal advice. If yu have any questins abut yur existing criminal backgrund, yu may wish t btain legal cunsel. PLEASE REVIEW THE MLT PROGRAM ESSENTIAL FUNCTIONS LISTED BELOW: Applicants must be aware f the expectatins (smetimes referred t as essential functins ) within the medical labratry field. They include: Visual Ability Sufficient visual acuity t: prficiently use the micrscpe includes ability t differentiate clrs and mrphlgical features interpret test reactins by differentiating clrs r degrees f cludiness, precipitatin, flurescence, r agglutinatin differentiate macrscpic characteristics f samples and rganisms discern vlume lines n pipette read cmputer screens, reprts and graphs read reagent labels, expiratin dates, and safety infrmatin recgnize and then interpret and respnd t nnverbal behavir such as when bserving a patient s respnse t phlebtmy Hearing Ability: Adequate hearing t answer phnes, alarms, and cmmunicate with patient and ther prfessinal Cmmunicatin Skills: Ability t cmmunicate in a culturally cmpetent manner especially in English bth verbally and in written frm When interacting with individuals, demnstrate respect fr all ages, genders, sexual rientatins, races, religins, disabilities, ethnic and cultural backgrunds Mtr Skills: Demnstratin f fine mtr skills and gd hand-eye crdinatin when palpating patient veins r when handling pipettes, venipuncture supplies, test kits, and ther equipment r instrumentatin Ability t lift up/carry 25 punds and t be able t reach higher than nrmal benchtps (up t 45 inches) Demnstrate psychmtr functin that will allw safe mvement within the labratry and in patient rms Intellectual Skills: Demnstrate the ability t apply universal precautins when necessary r when directed Ability t cmprehend technical / prfessinal materials as well as verbal instructins Ability t retain the MLT bdy f knwledge acquired during training and past experiences Behaviral Scial Skills Demnstrate ability t wrk prfessinally and ethically in stressful situatins Demnstrate ability t interact apprpriately with individuals f all ages, genders, races, disabilities, sexual rientatins as well as sciecnmic, religius, and cultural backgrunds Demnstrate ability t recgnize emergency situatins and respnd apprpriately Demnstrate behavirs, actins, attitudes and values (particularly integrity) cnsistent with the prfessinalism expected f MLTs Demnstrate adherence t the HCC Student Cde f Cnduct in all academic and clinical settings 2 9/8/15
Demnstrate cmpliance with HIPAA, Universal Standards, and ther safety regulatins APPLICANT INFORMATION PRINT NEATLY AND COMPLETE FORM IN ITS ENTIRETY HCC Student ID Number: Legal Cunty f Residence: Applicant s Full Name: first middle last Address: street address city state zip cde Telephne: Email: Are yu a U.S. Citizen? Yes N If n, please indicate Immigratin/Visa Status: Please indicate if yu have a prir degree: Assciate Bachelr Masters Dctrate Medical Dctr If s, in what field? What academic institutin? Have yu ever been adjudicated guilty r cnvicted f a misdemeanr, felny, r ther crime, r ther crime nt shielded under the Maryland Secnd Chance Act? Yes PRE- / CO-REQUISITE COURSES N DATE COMPLETED / PREREQUISITE COURSES LIST ACADEMIC INSTITUTION/S COMPLETING NOTE: All curses must be cmpleted with a grade f C r higher. Hwever, the verall science GPA must be a 2.25 r higher. ENGLISH COMPOSITION (ENGL-121) STATISTICS (MATH-138) 4 credits GENERAL BIOLOGY I (BIOL-101) ANATOMY & PHYSIOLOGY I (BIOL-203) GENERAL INORGANIC CHEMISTRY I (CHEM-101) PSYCHOLOGY (PSYC-101) PUBLIC SPEAKING (SPCH-105) The fllwing curses may be taken cncurrently with the first MLT curse. ANATOMY & PHYSIOLOGY II (BIOL-204) MICROBIOLOGY (BIOL-200) ORGANIC CHEMISTRY I (CHEM-201) 3 9/8/15
REQUIRED APPLICANT SIGNATURE Please see reverse side Carefully review and initial each item listed belw and then please sign and date. I understand that I may submit Supplemental Applicatins fr Admissin t mre than ne f the Nursing and Allied Health Prgrams. Hwever, nce I submit a $300 depsit t hld my seat in a prgram I will be required t withdraw all ther active Nursing and Allied Health Prgram applicatins. If nt already declared, I authrize the Office f Admissins and Advising t add #279 t my active learning prgrams. I understand that if admitted: I will be required t submit a nn-refundable $300 depsit alng with my Admissin Acceptance Frm by the given deadline. The depsit will hld a seat in the class and be applied t my Spring 2016 tuitin. If I d nt submit the depsit and frm by the given deadline, my admissin may be revked. I will be required t abide by cllege plicy as utlined in HCC s Catalg, Student Handbk, including the Student Cde f Cnduct, and the Medical Labratry Technician Student Handbk. I will be required t cmplete the requirements as utlined in my acceptance letter. I will be required t prvide the Student Health Frm with immunizatin and titer certificatins prir t enrllment in any clinical curse in rder t ensure the safety f patients in the clinical setting by the stated deadline r I will be dismissed frm the Prgram. I will be required t have a criminal backgrund check and drug screening prir t enrllment in any clinical curse in rder t ensure the safety f patients in the clinical setting by the stated deadline r I will be dismissed frm the Prgram. I will be required t btain Healthcare Prvider CPR Certificatin prir t enrllment in any clinical curse in rder t ensure the safety f patients in the clinical setting by the stated deadline r I will be dismissed frm the Prgram. I will be required verificatin f clr blindness study by the stated deadline r I will be dismissed frm the Prgram. I will be assigned and expected t participate in ff-site clinical experiences and will be respnsible fr my wn transprtatin and parking fees. Sites may be lcated in r arund the state f Maryland. My signature cnfirms that the infrmatin I have prvided n this applicatin is truthful, that I have read all instructins carefully and that I agree with all stipulatins as utlined in the applicatin and admissin prcess. In additin I acknwledge that I have been given the pprtunity t btain the necessary infrmatin abut the Medical Labratry Technician Prgram including the admissins requirements, academic standards and essential functins. X Applicant Signature Date 4 9/8/15
Hward Cmmunity Cllege is cmmitted t prviding equal pprtunity thrugh its educatinal prgrams, admissins and the many services it ffers t the cmmunity. It is the plicy f the cllege t abide by all applicable requirements f state and federal law s that n persn shall be discriminated against r therwise harassed n the basis f race, religin, disability, clr, gender, natinal rigin, age, plitical pinin, sexual rientatin, veteran status, genetic infrmatin r marital status. The Cllege reserves the right t change unilaterally, withut ntificatin, any requirement, fee r prgram if it is deemed necessary. 5 9/8/15