Revised 4/23/19 School of Health, Education and Human Services Health Program Application Florida State College at Jacksonville 4501 Capper Road, Jacksonville, Florida 32218 Personal Information: Please Print Student Name: EMPL # (number on back of student ID) _______________ Last Four of Social Security #: __________ In compliance with Florida State Statute 119.071(5), students should be aware that Florida State College at Jacksonville collects and uses social security numbers (SSNs) if specifically required by law to do so or if necessary for the performance of the College's duties and responsibilities. The College takes appropriate measures to secure SSNs from unauthorized access and does not release SSNs to other parties except as required to fulfill the College's duties and responsibilities. View full list of SSN collection purposes. Street Address: City, State, Zip Personal Email _________________________FSCJ Email _________________________ Home Phone: ______________________ Cell Phone: __________________________ Birthdate: ____________________ Sex: Male ☐ Female ☐ Race: Black ☐ American Indian ☐ Alaskan Native ☐ White (Not Hispanic Origin) ☐ Asian Or Pacific Islander ☐ Hispanic ☐ Certification: I, certify that all information given in this application is true and accurate to the best of my knowledge. I understand that if I have falsified any information, I am subject to immediate dismissal from the School of Health and Human Services program for which I am selected. I understand that all correspondence regarding the program will be sent to my Florida State College at Jacksonville email account. All applicants will be notified of their status 2 to 3 weeks after deadline date. Signature: Date ______________ Participation in any health science program requires a medical history and physical examination, including a record of immunizations. For programs that have clinical training components, students must complete a background check and drug screening. Students selected for admission into a program will be provided with the necessary health and screening forms. Students who are unable to complete the clinical requirements after acceptance into selective access programs are not eligible for refunds of tuition and fees. Medical Lab Tech Revised 4/22/19 School of Health, Education and Human Services Health Program Application Florida State College at Jacksonville 4501 Capper Road Jacksonville, Florida 32218 Thank you for your interest in the Medical Laboratory Technology program at Florida State College at Jacksonville. Please read the instructions carefully and complete the application in its entirety. The application deadline for admission into program is: Fall term – May 15 How to apply to the College You must be a student of the college before applying to the program. Be sure to follow the instructions below: 1. Go to www.fscj.edu 2. Click on “Apply” button 3. Click on “Create a new application” 4. Complete the form to create an account 5. There is a $25 fee for each type of admission application submitted to the college (No fee for program applications) 6. If you graduated from a public high school in Duval County (after June 1989), St. Johns County (after June 1993) or Clay County (after June 1992) county, the College will request an official transcript after we receive your application. If our request is not honored by the high school, students will be notified by mail to request their own official transcript. If you graduated from a public or private high school outside of Duval, St. Johns or Clay counties, please have your high school send an official transcript indicating your graduation date to: Admissions Office Florida State College at Jacksonville P.O. Box 40515 Jacksonville, FL 32203-0515 If you have attended any other college or university, please request each school to forward your official transcript to the above address. All post-secondary transcripts must be received and evaluated before a student can attend college credit orientation through FSCJ Smart Start. All transcripts must be received and evaluated to be approved for financial aid. 7. Apply for Residency 8. Complete College Assessment 9. Apply for Financial Aid and Scholarships 10. Schedule orientation through FSCJ Smart Start 2 How to Apply to the Program Before submitting this application, the following must be completed: 1. Complete all prerequisite courses for the Medical Laboratory Technology program. a. ENC 1101 English Composition I b. MAC 1105 College Algebra or higher MAC prefix course. c. CHM 1025C Introduction to General Chemistry. CHM 1032C or CHM 2045C may be taken in place of CHM 1025C. d. BSC2020C – Human Biology e. MCB2010C – Microbiology f. HSC1531 – Medical Terminology (for Health Professions) 2. Submit Health Program Application by one of the following methods: a. Email all documents to [email protected] (Preferred method) b. Hand deliver to the Health Career Information Center, North Campus, Building A Room 224. c. Mail to 4501 Capper Rd, Room A224, Jacksonville, FL 32218 Direct all questions to the Health Career Information Center at 904-713-4545 Status notifications will be sent to your FSCJ email account only. 3 ADMITTING PROCEDURES FOR FLORIDA STATE COLLEGE AT JACKSONVILLE 1 Please contact the Student Success office on any campus for an application to the college. Alternatively, you can apply online through our website: www.fscj.edu. CRITERIA FOR ADMISSION TO MEDICAL LABORATORY TECHNOLOGY 1. Students entering the program must apply for admission to both Florida State College at Jacksonville and the Medical Laboratory Technology Program. 2. Students are required to furnish transcripts verifying their education. Official transcripts must be sent directly to the college registrar’s office for evaluation to FSCJ transcripts. Only FSCJ transcripts are used to verify completion of prerequisites. 3. Students must have a minimum GPA of 2.5. 4. Students who complete the application process, supply the required information, and have completed the prerequisite courses are eligible for acceptance. 5. Due to limited clinical training space, the number of students accepted into the MLT program each fall will vary. 6. Students must place at college algebra, college reading (REA 1105), and English Composition I on the Florida (CPT) College Placement Test (or comparable documentation) College preparatory coursework, if indicated as necessary by the (CPT) placement scores, must be completed to receive final program approval for continuation. 7. Students whose native language is other than English and wishing to complete a degree program must be counseled/tested by the (ESOL) English for Speakers of Other Languages. For more information, contact Instructional Program Manager Meredith Moore, [email protected]. 8. The Medical Lab Program reserves the right to deny admission or require withdrawal of any student who, in the judgment of the department, gives evidence of being unable to perform the responsibilities and tasks required of the medical lab profession. 9. Once all applications have been reviewed, students with completed applications to MLT program on file and prerequisite coursework completed or in progress will be evaluated for acceptance to continue in the MLT program. All students will be notified of their status through FSCJ email (approximately 2 to 3 weeks). In the case that more students meet the criteria established above for continuation than there are spaces available, a selection process will be used, ranking students by the following factors: • Educational preparation • GPA 10. Students will be expected to complete a drug screen and background check prior to the MLT orientation. Details will be furnished in the acceptance letter. A positive drug screen or background check may prevent you from being placed in a clinical rotation and prevent you from being able to complete the program. 11. Students are required to submit health data, background checks, drug screens, and other information in MyClinicalExchange prior to clinical placement. 4 PROGRAM GOALS The program goals are to: 1. Provide an integrated medical laboratory science curriculum for the benefit of our students and community health agencies; 2. Provide a program of continuing education in medical laboratory technology for the benefit of our graduates and other professional medical laboratorians practicing in community health agencies. GRADUATE COMPETENCIES Upon graduation from the program, graduates will be able to demonstrate: Theoretical knowledge and technical skills in the clinical laboratory according to established laboratory standards Error recognition, and the ability to integrate and interpret analytical data, and establish a course of action to solve problems Professionalism and ethical behavior Skills consistent with philosophies of quality assurance, and continuous quality improvement. Safe laboratory practice to include maintenance of working environment, adherence to all safety rules and regulations, and appropriate test sample acquisition and handling Communication skills to ensure correct, effective, courteous and appropriate information transfer 5 Essential Functions Medical Laboratory Technology Essential functions (or technical performance standards) represent the essential non-academic requirements of the AS-MLT program that students must master to successfully participate in the program. Students must be able to affirm their ability to comply with the following functions: HEALTH: • Possess the physical, mental, and emotional health to maintain