.

Vanderbilt Program of Medical Laboratory Science

Program Application

Please complete the application online or print the application form and, upon filling it out, mail it to the program at:

Program of Medical Laboratory Science, 

Vanderbilt University Medical Center

4605 TVC                         

1301 Medical Center Drive

Nashville, TN 37232-5310

If you have any questions during the application process, feel free to contact:

holly.j.irby@vanderbilt.edu

615-322-8681                                       

Application

Vanderbilt University Medical Center

Programs in Allied Health

Program of Medical Laboratory Science

Application for Admission

Please complete all information. If a particular question does not apply to you, please put "NA". 

PERSONAL INFORMATION:

Full Name: 

Social Security Number: 

Date of Birth: 

Current Address: 

Home Phone #  

Cell Phone #

E-mail address: 

Permanent Address: 

OPTIONAL PERSONAL INFORMATION:

1. Do you have any children? 

If you answered yes to Question #1, how many children do you have, and what are their ages? 

2. What is/are your country(-ies) of citizenship?

3. Where were you born? 

4. What is your marital status? 

5. What is the name of your spouse/significant other? 

6. What is the address of your spouse/significant other?


 

EDUCATIONAL BACKGROUND:

List all colleges and professional schools attended, beginning with the most recent or current school. Please have official transcripts sent from all colleges and professional schools attended.

1. School Attended 

    School City & State 

    Dates Attended  to 

                                 

     Degree Earned (Type "3+1" if you will be completing      the requirements for your degree while in the MLS          program.) 

2.  School Attended 

     School City & State 

     Dates Attended  to 

                                  

     Degree Earned 

3. School Attended 

     School City & State 

     Dates Attended  to                                           

     Degree Earned 

4. School Attended 

    School City & State 

    Dates Attended  to

                                  

    Degree Earned 

5. School Attended 

    School City & State 

    Dates Attended  to 

                                  

    Degree Earned 


ACADEMIC HONORS/MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS:

PROFESSIONAL OR EMPLOYMENT EXPERIENCE: Include job title, employer, address and dates.

1. Position Title 

    Employer 

    Employer City & State 

    Dates of Employment  

                                    to      

 

ADDITIONAL EXPERIENCE & QUALIFICATIONS: Indicate any special experience or qualifications not covered in this form that you feel should be considered by the admissions committee. 

 

GOALS:
Briefly describe your professional goals and how pursuing a career in medical laboratory science will enable you to achieve them.

REFERENCES

Please submit the names and addresses of three professionals who are acquainted with your academic and or professional experience and your personal character. Please have the enclosed reference forms completed and returned to the address listed. References may also submit an additional open-ended letter of recommendation.

1. Name 

    Street Address 

    City 

    State 

    Zip 

    Phone Number 

    Email Address 

2. Name 

    Street Address 

    City 

    State 

    Zip 

    Phone Number 

    Email Address 

3. Name 

    Street Address 

    City 

    State 

    Zip 

    Phone Number 

    Email Address 


If accepted as a student in the Vanderbilt University Medical Center Program of Medical Laboratory Science, I agree to abide by the rules and regulations of the program. I wish for my name typed in the box below to serve as my signature and agreement to submit the application to the Medical Laboratory Science program. 

Signature of Applicant                                           

Date

 

Click here for a copy of the MLS Program Application in Word

 

PLEASE SEND ALL CORRESPONDENCE TO THE FOLLOWING ADDRESS:

Program of Medical Laboratory Science

Vanderbilt University Medical Center

4605 The Vanderbilt Clinic

1301 Medical Center Drive

Nashville, TN 37232-5310

(615)322-8681, Office of Holly Irby

E-mail: holly.j.irby@vanderbilt.edu

APPLICATION DEADLINE: November 1 for consideration for the program start date in first week of June.

NON-DISCRIMINATION POLICY STATEMENT

In compliance with federal law, including the provisions of Title IX of the Education Amendments of 1972, sections 503 and 504 fo the Rehabilitation Act of 1973, and the Americans With Disabilities Act of 1990, Vanderbilt University does not discriminate on the basis of race, sex, religion, color, national or ethnic origin, age, disability, or military service in its administration of educational policies, programs or activities; its admissions policies; scholarship and loan programs; athletic or other University-administered programs; or employment. Inquires or complaints should be directed to the Opportunity Development Officer, Baker Building, Box 1809 Station B, Nashville, Tn 37235. Telephone (615)322-4705 (VITDD); fax (615) 421-6871.

 

This page was last updated May 19, 2014 and is maintained by