MLT Application

Refer to the Application Procedures (https://www.canyons.edu/academics/mlt/prospective/application.php) to make sure you have completed the application process thoroughly and accurately.

  • Official Sealed Transcripts from all colleges attended (except COC) must be submitted to Admissions and Records before submitting application
  • Applicants who submit incomplete applications or who are missing any required documents will automatically be ineligible

 

Do you have a Social Security #?
College Degree Posted on Transcript?
  • Attach applicable documents (.pdf format only). You will attach your documents in the next step after submitting this initial form.
  • Must attach copy of high school transcript, OR copy of diploma, OR copy of GED certificate. If from foreign country, must provide translation.

 
Have you ever attended another Medical Laboratory Technician, Phlebotomy or Clinical Laboratory Science Program or any medical program which included placement in a clinical facility?
Previously applied to COC MLT Program?
Completed a COC MLT Program Remediation Plan?
Completed all required program prerequisites at the time of this application?
Are you a U.S. citizen?
Are you lawfully eligible to work in the U.S.?

List All Colleges Attended (include College of the Canyons, universities/military, USA/foreign; failure to list all colleges attended will result in ineligibility.)

Name of College Degree Earned Weight
more items
To list all college attended, use + and – to add or delete colleges.  One college per line.
Proficiency or advanced level coursework in languages other than English (list below):

Affirmative Action Information

This information is confidential and is gathered for statistical purposes only. The information provided below, or the failure to provide the information below, will in no way affect your ability to enter the nursing program.

Gender
Ethnicity
(All persons having origins in Europe, North Africa or the Middle East and not of Hispanic origin)
(All persons of Chicano, Mexican, Puerto Rican, Cuban, Central/South American, or other Spanish culture origin regardless of race)
(All persons having origins in the original peoples of North America and who maintain cultural identification by virtue of tribal association or community recognition)
(All persons having origins in the Far East, Southeast Asia, the Indian Subcontinent, or Pacific Islands, including the Philippine Islands)
(All persons having origins in any of the black racial groups of Africa and not Hispanic in origin)
Education
Highest level of education obtained to date

Persons with Disabilities

It is your responsibility to notify the Disabled Students Programs and Services office at the College with verified documentation from a health or learning specialist in order to receive reasonable accommodation.

Non Discrimination Policy

The School of Health Professions and Public Safety does not discriminate on the basis of ethnic group identity, religion, sex, age, color, national origin, marital status, sexual orientation, veteran's status, mental disability or physical disability including persons with AIDS/ARC/HIV in any of its policies, procedures, or practices. This non-discrimination statement covers admission and access to, and treatment and employment in the programs, services and activities.

File Uploads

Please attach the applicable documents needed to complete your MLT Application.

  • Essential Functions or Technical Standards (REQUIRED)
  • If you checked the box indicating no college degree posted, you must attach a copy of high school transcript, OR copy of diploma, OR copy of GED certificate. If from foreign country, must provide translation from an official agency.
  • If you have a Phlebotomy License you must attach a copy of it.
Maximum 10 files.
15 MB limit.
Allowed types: pdf.