MLSGO Student Application Form

Welcome to the MLSGO Student Application Form. Before we get started enter your email address below, and click continue to start the application process. If this is your first time filling out the application form, please note that your email address will be used to identify you in our database. If you are continuing an application, simply enter the email address you provided before and you will be able to resume the application. It is important you remember which email address you enter below.

WARNING: This form has an auto save function that saves your progress every time you click on the next button at the bottom of the page, per each section of the form. In the event that you cannot complete the application in one go, you can always resume at a later date using the email address you previously provided. You must fully complete at least the first page and click on the first next button for your progress to be initially recorded. Additionally, to navigate to previous sections, either click on the section title at the top, or the previous button at the bottom. Do not hit the browser's back button. Doing so will take you back to the beginning of the form. FINALLY, once you submit the form, you will not be allowed to submit it a second time, so it is important that you thoroughly review your application before you submit it. If you've already submitted your application and realize that you need to make a change, please contact the program director(s) at the school(s) you've applied to for further assistance. If at any time you run into a problem and cannot advance to the next page, please take a screenshot of the current page that you're on and email it to the program director(s) of the school(s) you're applying to.

To continue filling out the form, there is a brief section with MANDATORY questions you must agree to. Failure to do so will prevent the rest of the application form from loading. When you're ready, click the button below to begin.

Personal

Starting Year

Application For

Personal Info

First Name

Last Name

Middle

Maiden

Personal Email Address

Present Address

Street/Box #

City

State

Zip

Country

Phone Number

Permanent Address

Same as Present?

Street/Box #

City

State

Zip

Country

Phone Number

Contact in case of Accident/Emergency

First Name

Last Name

Middle

Street/Box #

City

State

Zip

Country

Phone Number

Education

Education (History & Credits)

Do you expect credit for clinical education to apply toward a degree? Yes No

If YES, what is the name of the institution granting the degree?

Current College Advisor

Colleges Attended (List Most Recent First)

College Name

Location

Dates Attended

Degree/Hours Earned

College Name 1

Location

Dates Attended

Degree/Hours Earned

College Name 2

Location

Dates Attended

Degree/Hours Earned

College Name 3

Location

Dates Attended

Degree/Hours Earned

College Hours Completed

Cumulative GPA

Major

College Info

Honors & Activities At College

Scholarships And/Or Grants

Technical or Professional Schools Attended

Courses

MLSGO Course List

Please complete the grid below by entering the Course Number, Course Title, and Grade received for each required course. Applicant must receive a C or better in the courses listed below. Any grade below a C in the following courses will need to be retaken prior to entry. If another class is used as a substitute in one or more of the courses below, applicant must receive a C or better in that course. If you have not taken a required course, please type N/A in each appropriate field.

Course

Course Number

Course Title

Grade

Course 1

Course Number

Course Title

Grade

Course 2

Course Number

Course Title

Grade

Course 3

Course Number

Course Title

Grade

Course 4

Course Number

Course Title

Grade

Course 5

Course Number

Course Title

Grade

Course 6

Course Number

Course Title

Grade

Course 7

Course Number

Course Title

Grade

Course List

List the courses in which you are currently enrolled and for which semester/quarter. If you are not taking any classes, please type N/A in the Semester field.

Semester:

Course Number

Course Name

Credit Hours

Course Number 1

Course Name

Credit Hours

Course Number 2

Course Name

Credit Hours

Course Number 3

Course Name

Credit Hours

Course Number 4

Course Name

Credit Hours

Course Number 5

Course Name

Credit Hours

Course Number 6

Course Name

Credit Hours

Course Number 7

Course Name

Credit Hours

Course Number 8

Course Name

Credit Hours

List courses in which you intend to enroll and for which semester/quarter. If you will not be taking any classes prior to program entry, please type N/A in the Semester field.

Semester:

Course Number

Course Name

Credit Hours

Course Number 1

Course Name

Credit Hours

Course Number 2

Course Name

Credit Hours

Course Number 3

Course Name

Credit Hours

Course Number 4

Course Name

Credit Hours

Course Number 5

Course Name

Credit Hours

Course Number 6

Course Name

Credit Hours

Course Number 7

Course Name

Credit Hours

Course Number 8

Course Name

Credit Hours

History

Have you ever been a member of the armed forces of the U.S.A? Yes No

If so, did your military experience relate to Medical Technology? Yes No

Have you ever been convicted of a felony or misdemeanor within the last seven years? Yes No

If Yes, please explain including date(s), charge(s), penalty(ies), and dispositions.

Note:

A conviction will not necessarily automatically disqualify you for admission. Rather, factors such as date of conviction, and seriousness or nature of the crime will be considered. However, false, misleading or incomplete information will likely result in rejection of your application or dismissal from an MT/MLS school.

Background Check Requirement

Applicants are required to obtain a background report from www.castlebranch.com. After you've submitted your application, and paid your application fee, you'll be given a button with a package code that you'll need to click on to complete the background check. This report will be used for all Oklahoma hospital-based MT/MLS programs to which you are applying.

Employment Record (List current to most recent employment first)

Employer Name & Address

Job Title/Duties

Supervisor

Dates Employed

Reason For Leaving

Employer Name & Address

Job Title/Duties

Supervisor

Dates Employed

Reason For Leaving

Employer Name & Address

Job Title/Duties

Supervisor

Dates Employed

Reason For Leaving

Employer Name & Address

Job Title/Duties

Supervisor

Dates Employed

Reason For Leaving

Employer Name & Address

Job Title/Duties

Supervisor

Dates Employed

Reason For Leaving

References (Please have two academic professors or university advisors complete the Academic Reference Form. This should be mailed directly by the academic professor/advisor to each program to which you are applying. List the information of the professors/advisors below.)

Professor Name

Phone Number

Email Address

Professor Name

Phone Number

Email Address

Professor Name

Phone Number

Email Address

Interests & Hobbies

In your own words please state why you are interested in medical technology and what you plan to do after completing your education

Payment

Permission to release personally identifiable information.

I do waive my right, under the Family Education Rights and Privacy Act of 1974 to release confidential references, recommendations, and grade transcripts to the Admission Committee to be used solely for assessing applicant eligibility.

Signed

Date

Print Name

I hereby declare that all statements given on this form are true and correct to the best of my knowledge.

Signed

Date

Print Name

Please indicate the programs to which you are applying.

Select Your Profile Picture (.jpg, .jpeg, .png, .pdf )

Please be aware that each school requires a mandatory $10 application fee. When you click on the verify button below, the form will first validate all of the information you've entered. You will then be asked to verify your choice of schools selected above. Only once you have verified your choice, will you be able to submit the application. Submitting the application will reroute you to a payment page with a PayPal Pay Now button for you to pay the selected application fee and another button for you to complete your mandatory background check with Castle Branch. We strongly suggest you click on the background check button before clicking on the PayPal Pay Now button. To avoid delays in processing, please make sure we can identify you from your PayPal payment.

PLEASE NOTE:

You are also required to mail a sealed copy of your official transcript(s) to each of the programs to which you are applying.
Some programs may have other mandatory documents you will need to fill out and submit before they consider your application process complete.
Once your application is received, the individual program director(s) will email you with a request for any additional information, and to provide status updates on your application.

Admission

Effective 2018: All applications can ONLY be submitted online via this website.