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University of WestFlorida
Clinical Laboratory Sciences Program
Selection into the Clinical YearApplication
1. Submit application materials by February 7, (or June 6for summerstarters) to:
Victoria Dubose, Office Administrator
Clinical Laboratory Sciences Program Building 58
University of West Florida
11000 University Parkway
Pensacola, Fl 32514
2. Complete the Application for Selection into Clinical Year found at https:sites.google.com/a/uwf.edu/cls-clinical-year-students/. If you are not currently a student at The University of West Florida, complete the Application for Admission to The University of West Florida and submit required documentation. Download and save the file to your H drive. Type directly into the form. Email the completed form to . You must include a scanned copy of your immunization record.
3. Using the Reference Forms in the application packet, request three (3) letters of recommendation. Two letters must be from academicians and one from an employer or someone (not a relative or friend) who knows you personally. References may be mailed to the address above, or emailed to
4. If you are not currently enrolled at UWF, forward official transcripts for all colleges and universities you have attended directly to the Program Director (in addition to the UWF Office of Admissions).
5. If you are already at UWF, by now you should have completed all the prerequisites and are taking Hematology and Diagnostic Micro I (and Immunology) in Spring semester. If you are applying in the summer, you should be taking the summer MLS courses.
6. Students with foreign degrees must submit a transcript evaluation from an agency approved by the ASCP Board of Registry. Check with the Program Director.
7. Eligible applicants will be invited for a personal interview by the Selection Committee
SELECTION CRITERIA
1. The Clinical Laboratory Sciences Program at The University of West Florida is a limited access program: that is, the enrollment is capped. Applicants must be in good academic standing with a minimum overall GPA of 2.8 on a 4.0 scale, and they must complete all prerequisite courses and other graduation requirements prior to beginning the clinical program. Candidates must be capable of performing the “essential functions” with reasonable accommodations
2. Candidates with GPA between 2.5 and 2.8 will be considered, if clinical slots are available and if the student shows merits other than GPA.
3. Candidates will be ranked in order on the basis of academic record, letters of recommendation, and the personal interview.
SELECTION COMMITTEE AND PROCESS
1. The Selection Committee is made up of representative members from UWF faculty and education coordinators from participating hospitals.
2. The Selection Committee will review the application materials and conduct the personal interviews. The selected candidates and alternates will be announced by the first week of April.
Application for Selection into Clinical Year
Clinical Laboratory Sciences Program
The University of West Florida
Application Deadline:2/7 or 6/6Date: ______
I. Personal Data:
Name:
(Last)(First)(Middle)
Student ID NumberDate of BirthSex*Race*
Nationality* Native Language*
Current Address:
Street
CityStateZip
Phone: Last 4 digits SSN ______email:
List any other names under which your education records are filed.
Type of Student: (Check which applies to you)
UWF native student (entered UWF as a freshman)A.A. transfer from a Florida Public Community College or University
Transfer from other university/college
4+1 student (already have a B.S. degree)
*Students are selected without regard to gender, race, nationality or ethnicity. These questions are asked to generate the diversity profile of the program.
II. Education: List in chronological order every college or university you have attended.
Current Academic Classification: Junior (<90 SH)______Senior (>90 SH) _____
Second undergraduate degree ______
Current UWF Grade point average ______(Use SASS audit for this information)
III. Course Work: Indicate courses completed at the time of application or their equivalent courses by listing the semester hours of credit and checking the correct column. Indicate the planned date for completion of other courses. Use your SASS audit for this information
Yes / No1. / General education requirements complete
2. / Have an A.A. degree from a Florida Public Community College
3. / Foreign language requirement met
5. Science and Math Prerequisites (or equivalents):
Course Number / Course Name / SH / Grade / In progressMAC 1105 / College Algebra
STA 2023 / Statistics
BSC 1010 or
ZOO 2010 / Gen Biology/lab or Zoology/lab
PCB 2131 / Cell Biology/Lab and
PCB 4703 / Human Physiology
or
XXX XXXX / Anatomy & Physiology I and Lab and
XXX XXXX / Anatomy & Physiology II and Lab
CHM 2045 / General Chemistry I/Lab
CHM 2046 / General Chemistry II/Lab
CHM 2210 / Organic Chemistry I/Lab
CHM 2211
CHM 3120 / Organic Chemistry II or
Analytical Chemistry /Lab
PCB 3063 / Genetics/Lab
HSC 3550 / Pathophysiology
BSC 3033 / Biochemistry I/Lab
PCB 4233 / Immunology/Lab
MCB 3020 / Microbiology/Lab
IV. Work Experience: (Include volunteer work and military experience). If you are currently working, indicate how many hours a week.
Employer / Type of Work / Dates of Employment From - ToV. License: Are you currently licensed as a health professional in the State of Florida?
Yes ___ No ___
If yes, name the profession______
Current license number ______
VI. Activities: (Clubs, hobbies, volunteer work, etc.)
VII. List any awards, scholarships or special recognitions you have received (in college, as well as others):
VIII. References: (The people you will be asking to mail the references form to Program Director)
If you are selected into the clinical year of the Program you will be required to apply and to be
eligible for receiving approval as a Clinical Laboratory Sciences Program Trainee by BCLP (Board of Clinical Laboratory Personnel) of State of Florida. The following questionnaire is part of the application for trainee license. If you answered yes to any of the following questions please provide documentation of adjudication and evidence of restoration of civil rights, when applicable.
Yes / NoHave you ever been convicted of a misdemeanor (other than traffic violations) or a felony?
Regardless of adjudication, have you ever been convicted of a violation of or pled nolo contendere to any federal, state, local statute, regulation or ordination, or entered into any plea, bargain or settlement, relating to a misdemeanor or felony?
In the last 5 years, have you been enrolled in, required to enter into, or participated in any drug or alcohol recovery program or impaired practitioner program?
Have you ever been convicted of, or entered plea of guilty, nolo contendere, or no contest, to a crime in any jurisdiction other than a minor traffic offense? You must include misdemeanors and felonies, even if adjudication was withheld by the court so that you would not have a record to of conviction. Driving under influence or driving while impaired is not a minor traffic offense for purposes of this question.
In the last 5 years, have you been treated for or had a recurrence of a diagnosed mental disorder or impairment?
In the last 5 years, have you been treated for or had a recurrence of a diagnosed physical impairment?
In the last 5 years, have you been treated for or had a recurrence of a diagnosed addictive disorder?
Have you ever had a license disciplined for sexual misconduct or committed any act in any other state that would constitute sexual misconduct?
Have you had any application for professional license, or any application to practice, denied by any state board or other governmental agency of any state?
Have you ever had any professional license or license to practice revoked, suspended, or any other disciplinary action taken in any state?
Have you been refused a license to practice, or the renewal thereof in any state? (The intent of this question does not pertain to the failure of previous examination)
Explanation of Yes for any questions above:
IX. Briefly explain why you want to become a Clinical Laboratory Scientist stating your future educational/career goals (you may attach a separate page).
Attach a copy of your immunization records for the following:
MMR (measles, mumps and rubella). Two dates are required, or a titer showing immunity.
Hepatitis B series. Three dates for series or titer showing immunity.
Varicella (chicken pox). Immunization or titer showing immunity.
If you did not have all of these immunizations, explain in the dialog box.
X. The clinical (hospital) affiliates of the UWF program include hospitals that not within driving distance of the university. You may be placed at any affiliate. If you have a compelling reason that you must stay in the Pensacola area, (e.g. children, own your home, etc), please state it here.
Statement of Understanding and Acceptance
I. I understand that it is necessary for The University of West Florida CLS Program to share my application materials with selection committee members. I hereby give permission for sharing my application file with authorized personnel associated with the Clinical Laboratory Sciences Program at The University of West Florida.
II. I have read the attached document entitled "Statement of Essential Functions" and have accurately provided the required information. I confirm that my answers and statements are true and accurate, and I agree to inform the Director of the Clinical Laboratory Sciences program should any of the information change prior to entry into the clinical program
III. I realize that with satisfactory completion of the clinical experience, including training at The University of West Florida and the hospital, I will be eligible to take the certification examinations in Clinical Laboratory Sciences. I realize that the opportunity to be trained at a UWF affiliate does not entitle me to a job at that Hospital.
If I am accepted into the clinical year of the Clinical Laboratory Sciences Program at The University of West Florida, I understand the responsibilities and confidentiality expected of me. I realize that physicians will rely on the accuracy of my work in diagnosing diseases and treating patients. Because of the quality of my work affects the health and even the life of patients, I agree to perform my clinical laboratory assignments with extreme care, thoroughness and accuracy. I also understand that I will have access to confidential information concerning patients, and agree not to discuss this information with anyone who is not authorized to receive it.
I understand that The University of West Florida reserves the right to dismiss a student for personal misconduct, academic cheating, incompetence, violation of UWF or Hospital regulations, and unsatisfactory grades. I may refer to the University Student Handbook, The Clinical Laboratory Sciences Handbook and the appropriate hospital handbooks for regulations and requirements
Signature* Date emailed
*Your electronic signature is acceptable. Receipt of this application by a valid UWF email constitutes electronic signature.
The University of West Florida
Clinical Laboratory Sciences Program
Statement of Essential Functions
Purpose: The purpose of this document is two-fold:
1. To assure that the students applying for selection into the clinical year of the Program are
cognizant of the essential functions and abilities necessary to perform adequately and to
succeed in the Clinical Laboratory Sciences Program; and to be proficient in duties and
responsibilities of a clinical laboratory scientist upon graduation.
2. To assure that the Clinical Laboratory Sciences Program, whenever applicable or feasible,
provides the necessary accommodation/s to students with disabilities to enable them to
perform the essential functions and achieve student learning outcomes in each area of
instruction.
First, read the accompanying document, "Essential Functions", found on the following page. This defines each standard and gives some examples of the necessity for each function. Select the statement that best applies to you.
The University of West FloridaClinical Laboratory Sciences Program
Standards for Essential Functions
FUNCTION / STANDARD / EXAMPLE ACTIVITY / I am capable of meeting these requirements / I am not capable of meeting these requirements / I am capable with the following accommodations (write below)Communication / Ability to interact with others in English, both verbally and in legible written form. Ability to read English. / Keep accurate records. Read and write procedures. Read and follow instruction in manufacturer's inserts. Explain procedures and results to patients, health care pro-viders, coworkers.
Hearing / Ability to gather information aurally or to adapt / Recognize instrument signals, alarms. Use telephone.
Interaction / Ability to interact with individuals or groups from a range of social, cultural, emotional and intellectual backgrounds / Establish and maintain rapport and trust with patients, coworkers, other health care professionals and general public.
Mobility / Ability to move from room to room, and to maneuver in small places, e.g. around instruments, between beds, benches, etc. / Move around hallways, laboratory, patient room, storage areas as necessary.
Motor Skills / Demonstrate/possess gross and fine motor skills to operate dials, switches, pipetting devices, smoothly inoculate agar, and to assist patients. / Reach and manipulate equipment, reagents and supplies. Assist patients as necessary.
Self Care / Ability to present a professional appearance as a lab representative. Maintain own health, hygiene and safety on the job. / Observe safety/OSHA policies. Practice Universal precautions.
Olfaction / Demonstrate sufficient olfactory sense to maintain environmental safety. / Use odors to assess specimens, tests, instrument malfunction and smoke in case of fire. Maintain a safe work environment.
FUNCTION / STANDARD / EXAMPLE ACTIVITY / I am capable of meeting these requirements / I am not capable of meeting these requirements / I am capable with the following accommodations (write below)
Temperament / Ability to work in high stress work place environment. / Perform duties in emergency situations; in situations with time and manpower constraints and high stress conditions.
Vision / Ability to accurately perform and assess laboratory procedures requiring microscopic examination as well as gross visual examination. / Distinguish colors and opacity. Discern fine agglutination, precipitation. Resolve 1 micron objects using a bright field microscope. Identify cells, parasites and other elements in microscopic procedure for diagnosis.
I have received, reviewed and understand the standards necessary to perform the essential functions of the Clinical Laboratory Scientist. I have indicated areas where I may need accommodation.
Signature* Date
*electronic signature received in official UWF email is acceptable.
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