ORANGE COUNTY COMMUNITY COLLEGE OFFICE OF ADMISSION
115 SOUTH STREET | MIDDLETOWN, NEW YORK 10940
This form must be filled out by students wishing to be considered for entry into the Medical Lab Technology Program in Fall 2012
and returned to the Admissions Office by February 1, 2012 for consideration.
Fall 2012 Medical Laboratory Technology Progam Application
Name (Please print legibly):_________________________________________________ Student ID#: A
Mailing Address:________________________________________________________________
City:_________________________State:_____Zip Code:________ Legal County of Residence:__________________
Phone Number:________________________ E-Mail:______________________________
Date of Birth:_________________
Have you ever been enrolled in a Health Professions program at an Associate’s degree level or higher either at SUNY Orange or
another college? Yes No Program:_______________________________
If yes, did you successfully complete the program? Yes No
Transcripts from all institutions will be reviewed as part of the admissions process. Please list all colleges previously attended:
____________________________________________________________________________________________________________
Academic Requirements:
Admissions Requirements
• High school diploma or GED.
• Eligible to take Freshman English I (ENG 101).
• Eligible to take Elementary Algebra (MAT 101) or have successfully completed Developmental Algebra (MAT 020)
• Students must attain a minimum cumulative GPA of 2.0.
Department Specific Requirements:
• Attendance at a Medical Lab Technology pre-admission orientation. At this orientation, students will receive and sign off on
information pertaining to health forms, drug testing, and criminal record policies. Orientation dates are available online at
www.sunyorange.edu/admissions/healthforms.shtml.
Students will be considered for admission into this program based on the completion of all academic and program specific
requirements, highest combination of cumulative GPA and credits completed towards the program (see reverse), and seats
available.
Students must meet all of the above requirements to be considered for admission into the program.
Selection Process
All Medical Laboratory Technology Admissions Requirements must be completed before February 1
st
in order for a student to
be considered for acceptance into the program for the fall semester.
Student Certification and Signature (please check one of the following):
I have attended a pre-Admissions Orientation within 3 years of my planned program start date (Fall 2009 semester or later).
I plan to attend/have attended a pre-Admissions Orientation this year. Include date attended/plan to attend (mo/yr)____________
My signature acknowledges that I have read and accept the admissions requirements listed above, and that all of the information
provided is accurate and complete.
Student Signature
Date:
For Office Use Only: Accept _________Alt_______ Checklist_______ Low Cum_______ No Deposit _____ Declined ____
Dept Chair/Designee Signature Date:
Admissions Signature Date:
