Fillable PHLEBOTOMY APPLICATION FALL 2020 (Wilson Community College)

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PHLEBOTOMY APPLICATION FALL 2020 (Wilson Community College)

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PHLEBOTOMY APPLICATION ∙ FALL 2020
Admission into the Phlebotomy program for FALL 2020 is by application, and only completed applications
will be accepted. There are fifteen (15) spaces available. Applicants must be at least 18 years of age. The
registration fee is $224, which includes $180 registration, $5 technology, $15 security, $2 accident
insurance, $16 malpractice insurance, and $6 CPR eCard.
Phlebotomy training prepares students to draw blood specimens from patients for testing and analyzing. A
phlebotomist maintains equipment used in obtaining blood specimens; use of appropriate communication
skills when working with patients; selection of venipuncture sites; the care of blood specimen; entry of the
testing process in the computer; as well as clerical duties associated with record keeping of blood tests.
The course consists of theory and clinical experiences in performing blood collection. CPR training is
included in this program. CPR is required for clinical experience. CPR is AHA Health Care Provider.
The Division of Continuing Education of Wilson Community College recognizes and is fully supportive of
clinical agencies that require a drug screen, background check, or fingerprinting on students. Costs of
these tests are the responsibility of the student. The College has partnered with Castle Branch for these
tests. No other provider will be accepted. The cost is $90. Students are required to sign up for the drug
screen and criminal background check at www.castlebranch.com; package code: WD71 (bgdt) background
and drug screen only. Students have ten (10) days after the class begins to sign up with castlebranch and
to complete the required tasks. Failure to do so will result in student not being able to continue in the
Phlebotomy Training and Clinical Experience.
APPLICATION REQUIREMENTS:
• Complete the Phlebotomy application on the reverse side. Application can also be downloaded
from the wilsoncc.edu website, Continuing Education, Health Occupations page.
• Submit completed application to mkilette@wilsoncc.edu or to the Continuing Education office on
campus, B105.
• Copies of the following are required and must be submitted with application:
• High School Diploma, High School Equivalency, or Transcript
• Valid Picture ID (example: unexpired driver’s license)
• Proof of following immunizations:
• Two TB skin tests (within twelve (12) months of class start date)
• Two MMR (Mumps, Measles, Rubella) injections
• Three Hepatitis B (at least the first injection is required prior to start of class)
• Varicella injection or Titer (blood test to prove immunity to chicken pox)
• Tdap (within the past 10 years)
• Flu vaccine – starting September 2020
It is the student’s responsibility to obtain and attach copies of the required immunization records to
application. Keep the original record and SUBMIT COPIES ONLY.
TEXTBOOKS REQUIRED:
•
The Phlebotomy Textbook 3rd Edition - (Approximately $75)
•
The American Heart Association CPR Textbook - (Approximately $20)
REQUIRED PRIOR TO CLINICAL ROTATIONS:
UNIFORMS: Purple V-neck shirt; white pants, white lab coat, and white, closed-toe shoes. The Instructor
must approve skirts and/or dresses prior to clinical rotation. Nametags are available in Building F prior to
clinical rotation. Nametags are required for Clinical. Students must be dressed professionally at all times
when in clinical setting. Body piercings and tattoos must be covered when in clinical. Instructor will inform
students of guidelines for dressing professionally.
PHLEBOTOMY APPLICATION for FALL 2020 ▪ Section # 36128
August 17 – December 9 ▪ 5 – 9 PM ▪ Mondays & Wednesdays of each week ▪ Building: G ▪ Room: 119
Clinical hours: off campus - 40 hours required (during daytime hours)
(Register by August 14)
Applications are now available on the WCC website or in the Continuing Education office, B105. Early
registration begins on July 6, 2020. Students wishing to have applications approved are welcome to call
252-246-1325 for questions regarding the approval process. Classes fill up quickly so early registration is
encouraged. Completed applications are accepted on a first come first served basis. The $224 fee is due
at the time of registration. The registration and approval process will continue until the day before class
starts or until the class is full.
NAME: Last: First: Middle Initial:
ADDRESS: City/State: Zip:
PHONE: Home: Cell:
EMAIL ADDRESS: NC ID:
BIRTHDATE: Month Day Year SEX: ❑ Male ❑ Female
RACE: ❑ White ❑ Black ❑ American Indian ❑ Hispanic ❑ Asian ❑ Other
EMPLOYMENT: ❑ Unemployed ❑ Part-Time ❑ Full-time EMPLOYER:
CAREER PLANS:
DO YOU HAVE PREVIOUS EXPERIENCE IN THE HEALTH FIELD? ❑ Yes ❑ No
IF YES, PLEASE LIST:
AGREEMENT
I have attached all required copies to my application; I have read, understand, and agree to all stated
requirements of the Phlebotomy program; I understand the required clinical dress code, and agree to
comply upon acceptance; I understand this is an application only and does not constitute acceptance into
the program. I understand that I will be dismissed from the program if documented as verbally or physically
abusive to college administration, clinical site staff, patients, or visitors.
SIGNATURE: DATE:
If any facility prohibits the student from participating in the clinical experience, the student will be
dismissed due to an inability to progress and complete the program.
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Completed 26 July 2020

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