Application Form for the School of Medical Technology/Medical Laboratory Science at UPMC Altoona

Complete the form below to apply today.

First Name Middle Name Last Name Maiden Name (optional) Email Address Phone Number Street Address Street Address 2 City State Zip Code Are you a U.S. citizen? Yes No School presently attending or graduated from: High School Rank (include total number of students in your class)

SAT Scores

Math Score Verbal Score

Post Secondary Education (beyond the high school level)

School Attended 1 Major Start Date End Date

School Attended 2 Major Start Date End Date

School Attended 3 Major Start Date End Date

School Attended 4 Major Start Date End Date

Emergency Contact: (in case of an accident, please notify):

Final acceptance into the program is contingent upon the applicant interview, successful completion of the junior year of college, where applicable, an acceptable transcript evaluation, and the findings of a complete physical examination as performed by a physician with Health Force at UPMC Altoona.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations

Consumer Information Disclosure

In December 1989, federal regulations were instituted that require all post-secondary institutions to provide all incoming students consumer information reflecting graduation, placement rates and licensure information in the career program being pursued by the student.

In an effort to comply with these regulations, the UPMC Altoona School of Medical Technology/Medical Laboratory Science is providing the following information based on its most recent graduate follow-up statistics.

View Graduation, Certification, and Placement rates of students.

I have read and understood the graduation rate, employment rate and certification information pertinent to the program. Yes No Your Full Name