AAS#SLT&Application&–&Rev.&2&(05/15)&
APPLICATION FOR ADMISSION
SCIENCE LABORATORY TECHNOLOGY
DELGADO COMMUNITY COLLEGE
615 City Park Avenue
New Orleans, LA 70119
(504
) 671-6419
Complete the general Delgado Community College admissions procedures before applying to Science Laboratory Technology Program.
Application must be typed. THE ADMISSIONS PACKAGE MUST INCLUDE: APPLICATION AND ALL OFFICIAL TRANSCRIPTS
OTHER THAN DCC. The admission package must be submitted to the Office of Admission, Science Laboratory Technology
Program. Incomplete packages will be returned to applicant and will not be considered for admission.
Semester for which applying:
Spring Fall
Concentration for which applying:
Biological Technology Chemical Technology Undecided
DCC LoLa ID# You must apply to DCC to obtain a LoLa ID#.
NAME:
Last First Middle Maiden
Mailing Address:
Number & Street City State Zip Parish
CONTACT NUMBER w/Area Code: ALTERNATE NUMBER w/Area Code:
EMAIL ADDRESS:
PERMANENT ADDRESS: (if different from above)
U.S. CITIZEN: Yes No
If no, type of visa: Resident Student Alien Regis. No. #:
In an emergency notify:
Name Relationship
Address Phone Number w/area code
List all schools/colleges attended, regardless of whether credit or a degree was earned (include current enrollment). Failure to
acknowledge attendance at a school/college/university may result in dismissal from the program.
SCHOOLS ATTENDED FROM TO DEGREE RECV’D
Semester/Yr Semester/Yr (i.e. BA, BS, AS)
High School (OR GED):
College(s):
Official transcripts of all colleges attended must be included with admissions package.
Have you ever previously applied to the Science Laboratory Technology Program? Yes
No
If yes, when did you apply?
Have you ever previously applied to other Delagdo Community College Programs? Yes No
If yes, to which program(s) did you apply? _________________________________
Have you submitted an application to Delgado Community College? Yes
No
AAS#SLT&Application&–&Rev.&2&(05/15)&
Present employment:
Name of company Address Phone
Position Immediate Supervisor
Background / Personal History Requirement: After admission to the AAS-SLT program and prior to enrollment into internship
courses, a personal history statement will be required. This statement requires truthfully answering the following five questions:
1. Have you been issued a citation or summons for, or has/have warrants(s) been issued against you related to, or have you
been arrested, charged with, arraigned, indicted, convicted of , pled guilty/”no contest”/nolo contendere/”best interest of” or any
similar plea to ; or been sentenced for any criminal offense, including all misdemeanors and felonies in any state or other
jurisdiction?
2. Have you been discharged from the military on ground(s) other than a honorable discharge?
3. Have you been diagnosed with, do you have, or have you had a medical, physical, mental or emotional or psychiatric conditi
on
that might affect your ability to safely practice as a science laboratory?
4. Have you had a problem with, been diagnosed as dependent upon, or been treated by mood-altering substances, drug or
alcohol
?
5. Ha
ve you been diagnosed as dependent upon/addicted to, or been treated for, dependence upon medications?
I have read the above and understand that I will be required to answer the five aforementioned questions after I am admitted to the
program.
Yes
No
Wr
ite a brief paragraph describing your reasons for Chemical Technology as a career, and for selecting the Delgado Community
College Science Laboratory Technology Program. What are your professional plans/aspirations?
I certify that the answers I have given to each and all of the foregoing questions are true to the best of my knowledge. I know that
falsification of any information on this form may adversely affect my admission to the AAS-SLT Program.
SIGNATURE: DATE:
Pl
ease keep this office informed of any changes in the information submitted on this application. Thank you.
Incomplete admission packages will be returned
click to sign
signature
click to edit
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