Application Period: June 1 - September 1
TEMPORARY
COVID-19 APPLICATION SUBMISSION PROCEDURES
Directions: Please complete each item by typing directly into the fields or neatly printing on a hardcopy, and
submit this Admission Application Checklist with all required documents to a Health Sciences Counselor via
UH File Drop. We will not be accepting in-person applications during this application period.
To use file drop follow the directions below:
1. Scan application and all supporting documents
a. If you do not have access to a scanner, use a free smartphone app like Scannable or Scanner Pro
or Cam Scanner. Save your application and all supporting documents in PDF format (do not
save as image formats ie. jpg).
2. From any web browser, go to https://www.hawaii.edu/filedrop
3. Log in as a UH User or Non-UH user (Non-UH Users will be sent a verification email, click on the link
in the email)
a. In the recipient field, type: hlthsci@hawaii.edu
b. Click in the drop down menu in the expiration timer, change it to 14 days
c. In the “Optional Message” field, enter FULL NAME and the PROGRAM you are applying to
d. After you’ve completed the Recipient field, extended the expiration timer, typed in the Optional
Message, click Proceed.
e. Click the Choose File button to browse for your application and supporting documents.
i. If you upload your docuemnts in different files (i.e. application, transcripts, etc), please
write a description of the file in the Description box.
f. Click the Start Upload button.
g. You will be redirected to a confirmation page with the link to your uploaded file. You’re
finished.
Please contact us at hlthsci@hawaii.edu or 808-734-9224 if you have any questions or need assistance
with these temporary application submission procedures.
Health Sciences Department
Kapi`olani Com
munity College
MEDICAL LABORATORY TECHNICIAN PROGRAM
Admission Application Checklist
7/20/2020
Application Period: June 1 – September 1
Directions: Please complete each item carefully typewritten or neatly printed, and submit this Admission Application Checklist and
all required documents to a Health Sciences Counselor via the COVID19 submission procedures. Only this completed program
Admission Application including supplemental documentation submitted by the appropriate deadline will be accepted for
processing. Applications must be submitted according to the COVID19 submission procedures.
APPLICANT INFORMATION
Name: UH Number/Username
Last Name First Name M.I.
Mailing
Address:
Street / POB City State Zip Code
Phone:
Cell Home Work
Are you a resident of a neighbor island?: Yes No If yes, which island: _________________
A
re you willing to complete your clinicals on a neighbor island?: Yes No If yes, which island: ________________
UH SYSTEM Email Address:
List other name(s) used on documents:
(Notify the KCC Kekaulike Information & Service Center regarding other names used on college documents.)
ADMISSION APPLICATION CHECKLIST FOR MLT PROGRAM
1.
Attend a Mandatory MLT Program Information Session.
For more information visit www.kapiolani.hawaii.edu or pick up an Information Session schedule from
Kauila 122 or Kauila 106 during posted business hours.
Date Attended: (Month / Day / Year)
2. Complete the online UH System Application if you are not currently enrolled at any UH System
institution during the semester you submit your application. (http://apply.hawaii.edu)
3. Prerequisite Courses must be completed with a “C” grade or higher or in progress of completion by the
end of the application deadline. Completion of the following program support courses is highly
recommended, but not required: CHEM 162, 162L, MICRO 130, MICRO 161.
4. College transcripts for courses completed within the University of Hawai‘i System. Print out
student copy of unofficial transcripts for all course work WITHIN the UH System and highlight all
pr
erequisite/qualification courses. UH system transcripts are downloadable from the UH Portal
(myuh.hawaii.edu
).
5. College transcripts for courses completed outside of the University of Hawai‘i System.
I
f transferring courses from institutions outside the UH System, please list the institution and when your
transcript was requested:
• Institution: Transcript Request Date:
Institution: Transcript Request Date:
• Institution: Transcript Request Date:
Health Sciences Department
Kapi`olani Community College
MEDICAL LABORATORY TECHNICIAN PROGRAM
Admission Application Checklist
7/20/2020
My external transcripts have been evaluated by KCC. Submit your transfer course report from
STAR accessible via the UH Portal (myuh.hawaii.edu).
My
external transcripts have not been evaluated by KCC. Submit unofficial copies with this
application, send official copies to the KCC Kekaulike Information & Service Center,
complete Online request for Transcript Evaluation. To complete this form, you must log in
with your UH Email account. Complete this form at: http://go.hawaii.edu/oxG
6. My Plan Initiative.” Complete self assessments
APPLICANT CERTIFICATIONS:
I certify that the answers and responses provided for all of the items on this Admission Application Checklist are true to the best of my
knowledge and belief. I understand that providing incorrect or false information will subject me to the requirements and/or discipline
measures as provided under the University’s Student Conduct Code. I understand that if I am not accepted into the program of
application, I must submit a new application and all required documents for any subsequent semester. I also allow KISC to change my
major and home institution if I am accepted into the MLT program. I understand that if I am not accepted into the MLT program, my
home institution and major will not change.
Health care students are required to complete University prescribed academic requirements that involve practice
in a University affiliated health care facility setting with no substitution allowable for the completion required
clinical practice. Failure of a student to complete the prescribed clinical practices shall be deemed as not satisfying
academic program requirements. It is the responsibility of the student to satisfactorily complete any criminal
background checks and drug testing that may be required by the affiliated health care facility to which he/she is
assigned for clinical practice in accordance with procedures and timelines as prescribed by that affiliated health
care facility.”
I understand that a criminal background check and drug test may be required for entry into clinical practice. ________
(please initial)
I understand that clinical practice is required for completion of this program. ________ (please initial)
I understand that priority selection is given to Hawai‘i State residents for tuition purposes and that non-residents will be
considered after all qualified residents have been accommodated per Board of Regents Policy. ________ (please initial)
P
rint Name ____________________________ Signature ________________________ Date_____________
EXAMPLE of how to complete the application:
These are the requirements
Tell us what class you took to meet each requirement
Circle Points
Course
Alpha
Credits
Term of
Completion
Institution Grade Points
LABORATORY TECHNICIAN
PREREQUISITES
A B C
ENG 100 Composition I (3) OR
ESL 100 Expository Writing: A Guided Approach
WRI 1200 3.0 Fall 2016 HPU B
12 9 6
MATH 103 Fundamentals of College Algebra
MATH 103
3.0 SP 2016 KCC A
12 9 6
Health Sciences Department
7/20/2020
CRITERIA FOR ACCEPTANCE:
Qualification is based on a rating system of grades for completed prerequisite and support courses. Selection is based on
total qualifying scores in rank order from the highest score until admission quota is met for the MLT program.
Course
Alpha
Credits
Term of
Completion
Where
Completed
(i.e., Institution
Name)
Grade Points
MEDICAL LABORATORY TECHNICIAN
PREREQUISITES
ENG 100 Composition I (3) OR
ESL 100 Expository Writing: A Guided
Approach (3)
12 9 6
MATH 103 Fundamentals of College Algebra
OR higher (3)
12 9 6
*BIOL 130 Anatomy & Physiology (4) OR
*BIOL 171 General Biology 1 (3) OR
*PHYL 141 & PHYL 142 Human Anatomy &
Physiology I & II (3 & 3)
16 12 8
*CHEM 161 General Chemistry I (3)
12 9 6
*CHEM 161L General Chemistry I Lab (1)
4 3 2
MLT 100 Introduction to the Clinical
Laboratory**
No points awarded
*Courses that must be completed within a 5 year time limit
Total Points for Prerequisites
(out of a max of 56)
PROGRAM SUPPORT COURSES
*CHEM 162 General Chemistry II (3)
4 3 2
*CHEM 162L General Chemistry II Lab (1)
4 3 2
*MICRO 130 General Microbiology (3)
4 3 2
*MICR 161 Immunology & Protein Chemistry (2)
4 3 2
A. S. Social Sciences course (3)
(100 level OR higher)
3 2 1
A. S. Humanities course (3)
(100 level OR higher)
3 2 1
*Courses that must be completed within a 5 year time limit
Total Points for Support Courses
(out of a max of 22 )
.
Application Summary: For office use only
Date Received: _____________________ Ethnic Code: ____________ KCC GPA: _______________
Counselor’s Initials: ___________ Application Complete: ____________ HI Resident: _____________
**Lab assistants with documented
phlebotomy experience may have this
requirement waived. See MLT Program
Director.
Health Sciences Department
Kapi‘olani Community College, Health Sciences and Emergency Medical Services Departments
4303 Diamond Head Road, Kauila 106 Honolulu, Hawai’i 96816-4421 Telephone: (808) 734-9224
Website: www.kapiolani.hawaii.edu
An Equal Opportunity/Affirmative Action Institution
The My Plan Self-Assessment is a counseling tool for prospective healthcare majors to help you identify and better understand
your career pathway, strengths, and areas of focus. Working in healthcare requires a combination of academic and professional
knowledge and skills and a commitment to public service. As you plan, find ways to make your strengths shine and to improve your
weaker areas. Please complete this self-assessment by marking the appropriate boxes. All response are voluntary. This assessment
does not affect your eligibility for admission. This assessment and is used for all ten Health Academic programs, therefore there may
be some statements that do not apply to your specific program.
Knowledge of the Profession
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Identifi
ed career goals in my health pathway
Identified career alternatives in my health pathway
Relevant experience by volunteer experiences
Relevant experience by servicing learning experiences
Relevant public serviceby paid work experiences
Understand “professional qualities” of health pathway(s)
Understanding of current healthcare issues
Comfort with bodily fluids or personal patient care
Comfort with illness
Comfort with injury
Comfort with death
Comfort with physical contact with people
Ability to multitask and adapt to change
Ability to accept constructive feedback
Ability to handle occupational crises, challenges or problems
Ability to move forward to achieve the goals and outcomes
Ability to follow safety guidelines and standards of practice
Personal Characteristics
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Demonstr
ate commitment to public service
Demonstrate empathy/altruism
Demonstrate moral/ethical integrity
Demonstrate emotional maturity
Demonstrate good interpersonal relationships
Accept responsibility
Ability to work independently to achieve the goal/task
Collaborate and teamwork to achieve the goal/task
Accept and demonstrate leadership
Be dedicated/hard-working healthcare practitioner
Committed to life-long learning
Kapi`olani Community College
MY PLAN
Self Assessment
Health Sciences Department
Reset
Academic Strength
Below
Expectations
Meets
Expectations
Exceeds
Expectations
+Completed prerequisites of health program of study
+Completed support courses of health program of study
Achieved minimum cumulative GPA for program entry
Achieved prerequisite course GPA for your program entry
Effective verbal and nonverbal communication skills
Ability to utilize technology effectively for learning
Established Support Systems to Succeed in
Health Pathway Program
Below
Expectations
Meets
Expectations
Exceeds
Expectations
Established support for transportation to externships
Established support for financial assistance prior to entry
Established support for nonacademic responsibilities
Established support for personal and time management skills
Established support for continuous professional learning
Established opportunities to balance personal, family, & school
Established support for campus and community resources
+As requir
ed for program entry and graduation or meet other requirements as directed for program admissions.
An Equal
Opportunity/Affirmative Action Institution
Kapi`olani Community College
MY PLAN
Self-Assessment
The University of Hawai‘i does not discriminate on the basis of race, sex, age, color, national origin, or disability. For
inquiries regarding our nondiscrimination policies, please contact the Kapiolani Community College designees:
Kelli Brandvold, ADA Coordinator for Employees and EEO/AA Campus Coordinator
Office: ‘Ilima 208
(808) 734-9575; kellib@hawaii.edu
Deneen Kawamoto, ADA Coordinator for Students Office: ‘Ilima 107
(808) 734-9522; deneenk@hawaii.edu
UHCC offers Career and Technical Education (CTE) Programs of Study leading to Associate of Science (AS) and
Associate of Applied Science (AAS) degrees, as well as postsecondary certificates, in career fields such as arts and
communications, business, health careers, industrial and engineering technology, natural resources, and public and
human services.
For more information, visit our website at http://uhcc.hawaii.edu/programs/index.php
.
UHCC applies an open access policy, with program admission based upon the completion of applicable course/testing
prerequisites. The lack of English skills will not be a barrier to admission and participation in CTE programs.
Health Sciences Department
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