Medical Lab Competitive Selection Request Form

Name*

First NameLast Name

Student ID*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

WGTC Email*

example@student.westgatech.edu

YesNo

Proof of attendance at a mandatory healthcare information session is required before submitting this competitive selection application. Please contact the Advising Center for details about upcoming session dates and times, or to schedule a one-on-one meeting with an advising coach.

YesNo

The Medical Laboratory Technology program requires the following courses to be completed by the application deadline. Each course must be completed with a minimum grade of C. In addition to earning a minimum grade of C in each course, an overall GPA of 2.5 or higher must be earned in the required courses. Specific technical, science, and Health Science courses must be completed within seven years of the start of the program cohort start date.

Please identify where and when each course was completed, and the letter grade attained. If you repeated a required course, please list information relative to the highest grade achieved. WGTC must have an official transcript on file for each college previously attended. Please view your WGTC academic history through Self-Service BANNER Web to find the dates and grades for specific courses completed with WGTC.

Required Courses. (If you did not take the class, please type "NA" in the fields.) *

Rows	College Where Completed	Date Completed	Letter Grade Earned
BIOL 2113
BIOL 2113L
BIOL 2114
BIOL 2114L
CHEM 1211 AND
CHEM 1211L OR
CHEM 1151 AND
CHEM 1151L

Bonus Points

Possible Bonus Points (maximum 3)

Submit an employer letter on company letterhead, including dates of employment, job title, and a brief description of duties for consideration.

One (1) point for six months of healthcare clinical work experience.
Clinical experience is defined as performing the duties as a Phlebotomist, Medical Laboratory Assistant, or Specimen Processor in a hospital, clinic, or physician’s office.
Two (2) points for six (6) to twelve (12) months of work in the healthcare field as a Phlebotomist, Medical Laboratory Assistant, or Specimen Processor in the clinical laboratory.
Three (3) points for more than one year equivalent of full-time experience as a Phlebotomist, Medical Laboratory Assistant, or Specimen Processor.

1 Bonus Points: Completed six months of healthcare clinical work experience. Clinical experience is defined as performing the duties as a Phlebotomist, Medical Laboratory Assistant, or Specimen Processor in a hospital, clinic, or physician’s office.2 Bonus Points: Complete six (6) to twelve (12) months of work in the healthcare field as a Phlebotomist, Medical Laboratory Assistant, or Specimen Processor in the clinical laboratory.3 Bonus Points: Completed more than one year equivalent of full-time experience as a Phlebotomist, Medical Laboratory Assistant, or Specimen Processor.

Please Upload Proof of Bonus Points

I understand that this request, along with supporting transcripts, test results, or licenses, must be received by the application deadline. I also understand that meeting the minimum requirements does not guarantee selection as there are a limited number of seats available.

Your student email address is the primary communication method; it is important to check it often for updates and important information about your competitive selection application

Date*

Date

Signature*

I confirm that I have completed all the requirements to compete for the selected healthcare program(s). I have reviewed the General Competitive Selection Procedures and Competitive Selection Program Statistics available at https://www.westgatech.edu/admissions/getting-started/competitive-selection-process/. I understand that if I am not selected for a program above, it is my responsibility to complete another Competitive Selection Form for the next selection term. If I am accepted to more than one program, I must notify each program with my decision by their indicated deadline. If I do not respond by the deadline, I forfeit my acceptance.

Once I accept a competitive selection program, the program’s admissions counselor will change my major to the accepted program.

As set forth in its student catalog, West Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, sex, age, religion, disability, political affiliation or belief, genetic information, disabled veteran, a veteran of the Vietnam Era, or citizenship status (except in those special circumstances permitted or mandated by law). The following persons have been designated to handle inquiries regarding the non-discrimination policies: Equity (Title IX) Coordinator: Melinda Hofius, AVP of Student Affairs 770.537.5722, 176 Murphy Campus Blvd., Waco, GA 30182; ADA (Section 504) Coordinators: Students: Zelma Jones, Career and Student Support Services Director, 770.824.5245, 176 Murphy Campus Blvd., Waco, GA 30182, Student504@westgatech.edu, Employees: Teresa Jiles, Assistant Director of Human Resources, 770.537.6056, 176 Murphy Campus Blvd., Waco, GA 30182, wgtcHR@westgatech.edu.