Sentara RMH Laboratory Schools - Online

MLS Online

Application for Admission

Sentara RMH Medical Center does not discriminate on the grounds of race, color, religion, national origin, sex, age, marital status, sexual orientation, family responsibilities or political affiliation.

The Sentara RMH School of Medical Laboratory Science - Online is certified to operate by the State Council of Higher Education for Virginia.

Date*

What class are you applying to Full Time or Part Time*

Full-Time (1yr) Part-Time (2yrs)

Name*

First Name

Initial

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Please list other names that you have used which may appear on requested documents such as transcripts

How did you hear about the school?*

NOTE: If an applicant is accepted into the Sentara RMH School of Medical Laboratory Science, a physical examination and drug screen, and background checks are also required.

Education

What is your present Grade Point Average?*

THE BACCALAURATE DEGREE MUST BE FROM A REGIONALLY ACCREDITED COLLEGE/UNIVERSITY.

NOTE: We will prepare you for the lab portion of the ASCP exam or any certification exam. We cannot change the non-lab (experience and/or undergraduate accreditation) requirement for any certification exam. We cannot guarantee that you will be able to sit for any exam.

Provide the names and addresses of the schools you have attended, the dates of attendance, and any degree(s) received.*

References

Contact your current lab manager and have them send a letter of recommendation to the Sentara RMH School of Laboratory Science

Work Experience

In the space below, list your work experience with the most recent employment first.

1. Date of employment

Supervisors name

First Name

Last Name

Company name

Employer's Address

Address Line 1

Address Line 2

City

State

ZIP Code

Job Title

Reason for leaving

2. Date of employment

Supervisors name

First Name

Last Name

Company name

Employer's Address

Address Line 1

Address Line 2

City

State

ZIP Code

Job Title

Reason for leaving

Interview

Acceptance into the Sentara RMH School of Medical Laboratory Science depends upon your references, analysis of academic courses and performance, and your personal interview. After all of your references and transcripts have been received and evaluated, an interview may be scheduled. The Program Director for the school will contact you regarding the date and time. However, to assist in this process, please indicate the two best days and times to schedule the interview (for example, “Monday, any time after 1:00 pm”). Interviews will be scheduled Monday through Friday only. - MLS

Applicants without United States citizenship only. What is your current Visa staus?

Signature

If I am accepted by the Sentara RMH School of Medical Laboratory Science, I agree to abide by the code of ethics and the general rules and policies of the school and the hospital, and I am responsible for my conduct at all times. In signing below, I also affirm that to the best of my knowledge, the previous information is correct and accurate.

Signature*

[clear]

Use your mouse or finger to draw your signature above