Applications accepted January 15-April 15
Date of Birth: NPC ID:
Print Name in Full:
Last Name First Name Middle Name
Cell Phone: Home Telephone:
Mailing Address:
Number & Street City State Zip Code
Social Security Number: G.E.D Certification? Yes No
High School:
School Name City State
Email Address:
List information concerning high schools, colleges, or university attended:
Name of Institution City & State Dates (From - To) Degree Received
List Work Experience:
Employer Location Dates (From - To) Description of Work
Have you previously applied to this program? Yes No Date:
Have you ever taken a college entrance examination? Yes No
ACT SAT Compass ASSET Other:
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: Between 8:00 a.m. - 4:00 p.m.
Last Name First Name
Cell Phone: Work Phone:
(Please complete page 2)
Y:\ NURSING\ SECRETARY_FOLDER\ AccessibleDocuments\ MLT\ MLT_application_NPC 2019_2020.docx (Revised 19)
How did you hear about this program?
1. Have you ever been convicted of a felony or a misdemeanor? Yes No
2. Do you have a felony charge pending? Yes No
If yes on either of the previous questions, submit an explanation of the felony and/ or misdemeanor, including dates and specific
details. Place it in a sealed envelope addressed to the Dean of Nursing and Health Sciences and attach it to this application.
For your application to be considered complete you must complete the following:
1. Apply to NPC if you are not currently a student.
2. Attach unofficial transcripts from all colleges or universities attended, including NPC.
3. Attach a copy of standardized test scores (COMPASS, ACT, or SAT) if you have never attended college.
4. On a separate sheet of paper, please answer the following questions
a. Why did you choose Medical Laboratory Technology as a career?
b. What planning have you done to provide for adequate preparation and study time?
c. What are your future goals?
5. Provide 3 letters of recommendation. We do NOT accept recommendations from family member.
Please save the completed copy of this application and print. To finalize this application, submit a signed
hard copy to the Division of Nursing & Health Sciences.
Refer to the NPC website or the NPC catalog for the essential functions and/or technical standards required for each Nursing
and Allied Health program before submission of this application. National Park College provides academic accommodations as
mandated by ADA and 504. Please contact NPC’s Compliance officer at (501)760-4227 for reasonable accommodations under
the American’s with Disabilities Act (ADA) and for disability assistance information.
Falsifying any records pertinent to this application can lead to ineligibility or immediate dismissal from the Medical Laboratory
Technology Program. I understand that falsifying my application is dishonest and demonstrates a lack of integrity which could
compromise my acceptance and/or licensure. (PLEASE INITIAL)
I understand the health care industry requires a criminal background check and drug screening upon employment and random
drug testing throughout employment. I also understand that a criminal background check will be required at the time of
admission to the program. I understand that the Substance Abuse Policy of NPC Medical Laboratory Technology Program may
require drug testing during my enrollment for the following reasons: 1) Upon admission into the program. 2) Scheduled testing at
unannounced times throughout the program. 3) Random testing as required by the clinical agencies. 4) For cause.
: Date:
National Park College, in compliance with Title VI of t he Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972 Higher Education Act does
not discriminate on the basis of race, color, national orig in, sex, or qualified handicap in any of its policies, practices, or procedures . The provision includes,
but is not limited to, admissions, employment, financial aid, and other educational services. Any person having inquiries concerning NPC compliance with Title IX
is directed to contact the Dean of Students Office on the second floor of the Student Commons or by telephoning (501) 760-4229.
Return the Complete Application and all Documents to:
Nursing & Health Sciences Division- Frederick Dierks
Medical Laboratory Technology Program Director
101 College Drive: Hot Springs, AR 71913