Fillable PERSONAL GOAL STATEMENT (Northern Illinois University)

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PERSONAL GOAL STATEMENT (Northern Illinois University)

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MEDICAL LABORATORY SCIENCES PROGRAM
Northern Illinois University
PERSONAL GOAL STATEMENT
1) Please type in black neatly.
Name ________________________________ Student ID No. _________________________
Current Major _________________________ Date: _________________
Write a personal goal statement explaining why you would like to be accepted by the
Medical Laboratory Sciences Program and what you would like to do with this career.
Include any of the following, if applicable to you: a. ability to balance multiple
responsibilities such as athletics, employment and voluntary work, b. prestigious awards or
honors, c. primary leadership roles, d. laboratory experience.
MEDICAL LABORATORY SCIENCES PROGRAM
Northern Illinois University
STUDENT INFORMATION FORM Part I
NAME:_________________________________________________________ZID______________________
PERMANENT ADDRESS: _________________________________________________________________
(Street, City, State, Zip Code)
PERMANENT PHONE (area code) :
NIU (local )ADDRESS: _____________________________________________________________________
(Street, City, State, Zip Code)
NIU(local) PHONE # (with area code)and/or cell #________________________________________________
E-MAIL ADDRESS: _____________________________________________________________________________
Have you previously attended NIU? _____Yes _____No
If yes, what was your last term of enrollment? _____
ACADEM
IC INFORMATION
College/University Major
Cum
GPA
Credit
Hours
Degree (if
applicable)
TO MONITOR COMPLIANCE WITH CIVIL RIGHTS LEGISLATION, FEDERAL AND STATE AGENCIES REQUIRE
THAT UNIVERSITIES DESCRIBE THEIR POPULATIONS.
PLEASE COMPLETE AS MUCH AS POSSIBLE.
Birth Date
Gender
male
female
Ethnic Origin
American Indian or Alaskan Native
Asian or Pacific Islander
Black/African/Non-Hispanic
Other:
Hispanic
White/Caucasian/Non-Hispanic
Prefer not to respond
MLT/CLT Certified
YES NO
MEDICAL LABORATORY SCIENCES PROGRAM
Northern Illinois University
STUDENT INFORMATION FORM
Part II
Please provide information regarding the prerequisite courses in-progress or planned.
ACADEMIC INFORMATION
SEMESTER
(Identify Semester/Year to
be taken)
NAME OF IN-
PROGRESS OR
PLANNED COURSES
COLLEGE or
UNIVERSITY
TRANSCRIPT
SENT TO
NIU
Comments:
MEDICAL LABORATORY SCIENCES PROGRAM
Northern Illinois University
ESSENTIAL FUNCTIONS
The following are basic standards of physical and emotional health and communication skills
required for participation in the clinical setting. They have been developed in compliance with the
American Disabilities Act and the National Accrediting Agency for Clinical Laboratory Sciences.
1. Adequate physical health to meet job requirements and not endanger the health of the student,
patient, or employee.
2. Adequate emotional health to work safely and accurately under stress.
3. Adequate hand-eye and fine motor coordination to fulfill the technical requirements of the
profession.
4. Ability to hear using assistive devices, if necessary; e.g., phone receivers, hearing aids, etc.
5. Normal or corrected eyesight in order to safely and accurately perform patient testing. Color
blindness does not disqualify a student from entering the program, but it must be noted in order
to accurately interpret color-related testing.
6. Ability to use oral and written communication effectively in English and to read, understand, and
follow directives printed in English. Students applying whose native language is not English
may be required to document mastery of the English language through performance on the Test
of English as a Foreign Language (TOEFL), or equivalent and demonstrate effective oral
communication skills.
All persons applying for admission to the Medical Laboratory Sciences major must sign and return
this form with their application materials indicating that they have read, understood, and are
prepared to meet the above standards.
----------------------------------------------
Please complete, sign and date this form. Return ONE signed form with your application
materials, and keep the second copy for your files.
_____NO
I have read the technical standards.
_____NO
I understand the technical standards.
_____NO
I am prepared to meet the technical standards.
_____NO
I certify that the statements I have made on this application and all other application
materials submitted are complete and true.
Signature_________________________________________ Date______________________
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PERSONAL GOAL STATEMENT (Northern Illinois University)

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Completed 17 February 2021

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