Medical Laboratory Technology

AAS

Fall 2020 Application Packet

Applications are due April 24th, 2020 by 4:00 PM. Once applicants have met all the program criteria, selected students will be interviewed by MLT staff, objectively assessed on rubric then notified of their admission status into the MLT Program by mid-June 2020. E-mail with the application as an attachment including the GPA calculator as an active file to: Terry Kotrla tkotrla@fvcc.edu and Janice Alexander jalexand@fvcc.edu Any Questions, Contact: Janice Alexander, MLT Program Faculty Advisor, (406) 756-3948, RH 107, jalexand@fvcc.edu

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Dear Medical Laboratory Technology Program Candidate: We are excited you are considering Flathead Valley Community College (FVCC) to pursue your medical laboratory technology degree! The FVCC faculty, staff and administration are committed to your success. FVCC’s Medical Laboratory Technology Program will provide you with a solid foundation on which you can grow and develop a promising future as a medical laboratory technician (MLT). Our goal is to provide you with an up-to-date education and clinical experiences to prepare you for successful entry into the workforce. We accept four to six students per year, plus two who are placed on a waiting list, into the MLT program. The small class size is advantageous to our students, allowing more individualized attention and a greater amount of hands-on experience. Also, to be in compliance with our national accrediting agency we cannot accept more students than we have clinical spots for. This program is designed for students with high levels of motivation and professionalism. The program coursework and clinical rotations are challenging, demanding and time consuming. It is your responsibility to reap full benefit from your coursework and clinical education by actively participating and dedicating your time and efforts to the program to be successful. Exceptional time management is crucial for successful completion of the program. We encourage students to work hard, demonstrate the highest level of skill possible during the laboratory rotations, treat everyone with respect, and behave with integrity. The effectiveness of your education and skills is determined not only by constant practice and study, but also by your attitude and behavior. A sense of professionalism should be incorporated into all classroom, laboratory, and clinical experiences. Finally, part of our job at FVCC is to teach you that learning is a lifetime process. Graduation from this program, passing your certification exam, and successfully working your first job isn’t the end. Our profession is changing and growing rapidly. To meet the changing health care needs and to provide quality service, you must keep learning. The faculty will work to teach you how to keep that process going and to use your resources by: joining the American Society of Clinical Pathology (ASCP), participate in continuing education courses, reading journals, asking questions, and consulting with others. Proof of professional development is required to maintain your certification. Develop a desire for lifelong learning! Please review the Medical Laboratory Technology Student Handbook for detailed program information. Best wishes as you take the next step to enter the FVCC Medical Laboratory Technology Program. Sincerely,

Terry Kotrla, MS, MT(ASCP)BB Program Director Medical Laboratory Technology Program Flathead Valley Community College tkotrla@fvcc.edu

Denise Pacovsky, MLS(ASCP)CM Program Coordinator Medical Laboratory Technology Program Flathead Valley Community College dpacovsky@fvcc.edu

Janice Alexander, Ph.D. Faculty advisor Medical Laboratory Technology Program Flathead Valley Community College jalexand@fvcc.edu (406) 756-3948

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MLT APPLICATION REQUIREMENTS AND INSTRUCTIONS:

NO LATE APPLICATIONS WILL BE ACCEPTED. Applications must be submitted via email to Terry Kotrla tkotrla@fvcc.edu with cc. to Janice Alexander jalexand@fvcc.edu. Contact information will be entered into the tracking system. It is the individual’s responsibility to contact the MLT faculty advisor with changes in address or phone number. The secondary application form (GPA calculator) must be uploaded as an attachment to the email as the excel spreadsheet file. Excel is available in FVCC campus computer labs. The submitted application consists of the GPA calculator file, student essay, pages 3-6 and 9 of this application, and the two letters of recommendation (see form on last page). Letters of recommendation are to be sent separately via email by the reference from their email address directly to Terry Kotrla/Janice Alexander. If student transcripts from all current and prior institutions are on file at the FVCC admissions office transcripts do not need to be submitted, otherwise transcripts must also be submitted. FULFILLMENT OF THE MINIMUM REQUIREMENTS DOES NOT GUARANTEE ACCEPTANCE INTO THE MEDICAL LABORATORY TECHNOLOGY PROGRAM.

• All candidates who meet MLT application requirements will be considered for acceptance. • An objective point system using a rubric will be used to determine a score for final acceptance

into the program and will include points awarded for: o Completed application form, o GPA o Essay o Phlebotomist or clinical laboratory assistant job verification o Interview performance o Reference forms o Prior education.

• Any discrepancies in application criteria must be discussed and signed off with the Program Director prior to assumption of meeting admission criteria.

• Students who have taken courses more than one time, the highest grade will be used for GPA calculation.

• Students who have taken a higher-level course than a pre-requisite course may utilize the grade for admission purposes, if the grade received was a C or higher and is approved by the Program Director.

• The number of students accepted into the Medical Laboratory Technology Program is limited to 6 students with 2 on the waiting list.

• If the number of qualified applicants exceeds available spaces, not all qualified applicants will be accepted.

• A tie will be broken down by combined rubric score of selective GPA and interview total followed by combined Microbiology for Health Science and Introduction to Organic & Biochemistry GPA.

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Student Name PRINTED: ___________________________ Signature Form: • Initial each item on the line provided. • Sign your name on page 6. Your signature confirms agreement and that you have provided the

requested materials in your application. • Incomplete applications will not be accepted. I have completed the FVCC Application for Admission (degree seeking) and followed the steps for enrolling at FVCC. IMPORTANT: Admission to Flathead Valley Community College does not guarantee acceptance into the Medical Laboratory Technology Program. Students entering FVCC with the intent to becoming an MLT may declare an Associate of Science in MLT upon admission but are not accepted into the MLT Program until after a formal application, interview and selection process occurs. I have completed the MLT Application Form: A completed Medical Laboratory Technology application form (pg. 6) with your signature. NOTE: Incomplete applications will not be accepted. I have completed or am currently enrolled in the required prerequisite courses:

• You must earn a grade of C (2.0) or higher in all MLT pre-requisite classes • Credits are accepted for prerequisites only if a letter grade appears on the official college

transcript. If a college grade is not assigned to the course, the course needs to be completed to complete the prerequisite unless otherwise approved by the program director (e.g. AP courses)

• The FVCC MLT program assumes that students applying for the program have had experience with basic computer skills and keyboarding. Students are responsible for obtaining these skills independently if they do not meet this technical requirement.

• Phlebotomy requirement may be met by the FVCC AHMA 220/221 courses; current certification as a Phlebotomist by the ASCP or equivalent nationally recognized organization; completion of a NAACLS approved Phlebotomy program; completion of a formal two-part training program in phlebotomy which contains a minimum of 40 clock hours of classroom training and 100 clock hours of clinical training including: anatomy and physiology of the circulatory system, specimen collection, specimen processing and handling, laboratory operations, minimum performance of 100 successful unaided blood collections including venipunctures and skin punctures; completion of at least one year of full time (32 hours per week) work experience as a phlebotomist within the last five years, including venipunctures and skin punctures as part of their regular duties.

I have provided transcripts and evaluation of transfer courses. You must include copies of transcripts from other colleges or universities that you have attended and are requesting to be considered for transfer of credit. If the official transcripts are on file with the FVCC registrar, transcripts do not need to be submitted. Official transcripts must be on file in the FVCC registrar’s office for transfer of credit to be considered. I have completed the GPA calculator Excel file and will send as an attachment with my completed application. This is checked for accuracy. If you are completing classes for spring semester, please leave class grade blank.

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Ensure Professional References (2) complete the professional reference forms and the references email the forms directly to Terry Kotrla, copy to Janice Alexander. The form is provided at the end of this packet, one form must be from a faculty member of a pre-requisite course. Official documentation of previous degrees or health related certifications or health work

experience (if applicable): • Letter from employer on company letterhead documenting work experience as phlebotomist or

clinical laboratory assistant (if applicable). • Certificates of completion

Completed Autobiographical Essay: Submissions must be in a word-processed/typed format no more than 3 pages long, double spaced, no smaller than Times New Roman 11-point font. Applicants will be graded upon the following content areas:

• Content must include each of the following: 1) Interests and goals in pursuing a career as a medical laboratory technician, 2) Experiences in any health care field or in your life which directly relates to your knowledge of and interest in medical laboratory technology 3) Personal strengths which will allow you to successfully complete the program and function effectively as an MLT.

• Structure - spelling, grammar, punctuation and outline • Composition - theme, flow of thought processes, and expression

IMPORTANT: I understand that final admission to the program is contingent upon completing a successful criminal background check and all immunizations required for clinical rotations by facility partners.

• After initial acceptance into the program, students will be given instructions and a link to create a CastleBranch account. Cost is $102.00 and is the responsibility of the student.

• CastleBranch will conduct a criminal background check. Clinical facilities require backgrounds check for security purposes on individuals who provide services within the facility and especially those who supervise care and render treatment. Clinical rotations are an essential part of the program. Students who cannot participate in clinical rotation due to criminal or other adverse activities that are revealed in a background check are unable to fulfill the requirements of the program. This decision is made solely by the healthcare facility partner and not FVCC. Additionally, licensing agencies may require individuals to pass a criminal background check as a condition of licensure. Therefore, it is in everyone’s interest to resolve these issues prior to final acceptance into the program. Discrepancies may result in students being denied final acceptance into the program.

• FVCC is NOT obligated to make special accommodations if discrepancies are found in background check results and will not find an alternative clinical site if disqualified based on the site’s policy. Students that are not able to complete the clinical aspect of the course will NOT be able to satisfy the requirements of the MLT program.

• Drug screens may be required during the course if there is reasonable suspicion that faculties are impaired at clinical sites or in classrooms as a result of the use of a controlled substance or alcohol consumption. Students may be tested if a preceptor, class instructor, and/or clinical instructor makes specific, contemporaneous, articulable observations concerning the appearance, behavior, speech, or body odor of a student which indicates reasonable suspicion of impairment by either chronic, acute, or withdrawal effects of alcohol or controlled

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substances. Screening may also be required if there is reason to believe a student act or failure to act is a cause of an accident at a clinical site that causes personal injury or property damage.

• CastleBranch will prompt students to submit ALL of the following required immunizations and documents for clinical rotations: o Two (2) MMR’s or titers o Two (2) Varicella vaccines, positive titer or physician documented record of having chickenpox o Positive Hepatitis B titer or signed declination o Tdap (this cannot be TD or other combination must be Tdap and within the last 10 years) o Yearly flu shot (only during flu season in the month of October) o TB testing – two options.

Two-step TB skin test requires four visits. Give the first test and return in 48-72 hours to read. Return within 7-21 days to receive a second test. Return in 48-72 hours to have it read.

The Quantiferon TB blood test may be done in place of the skin test. Either option must be completed within the last 12 months.

o CPR recommended, but not required. o If there are any questions regarding immunizations call Sam Kujala at 406-756-4364.

Students taking more than 6 credits have the option to utilize the Student Health Clinic and can contact them at 406-756-4331 for information on costs, billing, and appointments.

I acknowledge, by initialing here, that if accepted into the MLT program I will need to provide a

photo through the Kalispell Regional Healthcare (KRH) website form and complete the online KRH Forms. The photo will be required for a student ID badge that KRH will provide once cleared for clinical rotations. • Students participating in clinical work at Kalispell Regional Medical Center will be required

to read through the student checklist and orientation manual, read through disclaimers and policies, and complete the Student Personal Information Form.

• The student must complete an online personal information form in case of emergencies and to receive a parking sticker.

_______I understand that I will be notified in writing after June 8th, 2020 whether I have been accepted into the MLT Program for Fall Semester 2020. Students must respond to the FVCC MLT Program Director in the writing of their choice, email or letter, to accept or decline their position in the MLT program within one week of being accepted into the program. Students who are put on the waiting list will be accepted if and only if an opening occurs. The waiting list is maintained only until the first week of Fall Semester 2020. Students who are not accepted may reapply for acceptance into a following year program during the open application process.

______I understand that acceptance into the FVCC MLT Program is dependent upon sufficient financial,

faculty and clinical resources. ______I understand that upon withdrawal from the program for any reason, re-entry into the program is

not guaranteed. ______I have retained a copy of this application for my records. It is my responsibility to make my own

copies and I understand that my application and its contents are property of FVCC MLT program. ______I have signed the Essential Functions Verification Form (pg. 9).

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FVCC Medical Laboratory Technology Application

Flathead Valley Community College does not discriminate on the basis of race, color, national origin, sex, age or handicap in admission or access to, or treatment or employment in its educational programs or activities. See Mont. Code Ann. § 49-2-307 INCOMPLETE AND/OR UNSIGNED APPLICATION PACKETS WILL NOT BE PROCESSED.

PLEASE PRINT OR TYPE PERSONAL INFORMATION

Last Name First Name Other MI Home Address: Number & Street, Apt. # City State Zip Code FVCC Email Address Personal Email Address Primary Phone Number Alternate Phone Number

Date of Birth Student Identification Number

*EDUCATION – Must send official transcripts to college and copy to program. Institution City/State Dates (month/year) Degree Awarded

* If official copies of transcripts are on file in the FVCC Admission Office, photocopies are acceptable to include with this application. (These are available to download and print from your student portal.)

CERTIFICATES Institution City/State Dates (month/year) Type

I certify that all statements in this application and all of the documents submitted with this application are true and accurate to the best of my knowledge. _________________________________________________ __________________ Student Signature Date

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ESSENTIAL FUNCTIONS OF A MEDICAL LABORARORY TECHNICIAN Medical Laboratory Technician (MLT) programs establish technical standards and essential functions to ensure that students have the abilities required to participate and potentially be successful in all aspects of the respective programs. Satisfactory completion of the MLT Program and successful employment following graduation demands your ability to meet the following technical standards and essential functions requirements, with or without reasonable accommodations. If you are uncertain as to your ability to perform any of these essential functions, please consult with the MLT Program director or faculty advisor. Please read carefully and document that you have read and understand these on the “Essential Functions Verification” form that follows. 1. Observational - Ability to participate actively in all demonstrations, laboratory activities and clinical

experiences in the professional program component. Such observation and information requires functional use of visual, auditory and somatic sensations. a. Observe laboratory demonstrations in which biological (i.e., body fluids, culture materials, tissue sections,

and cellular specimens) are tested for their biochemical, hematological, immunological, and histochemical components.

b. Characterize the color, odor, clarity, and viscosity of biological, reagents, or chemical reaction products. c. Employ a clinical grade binocular microscope to discriminate among fine structural and color (hue,

shading, and intensity) differences of microscopic specimens. d. Read and comprehend text, numbers, and graphs displayed in print and on a video monitor.

2. Movement - Sufficient motor ability to execute the movement and skills required for safe and effective performance of duties. a. Move freely and safely about a laboratory. b. Reach laboratory bench tops and shelves, patients lying in hospital beds or patients seated in specimen

collection furniture. c. Travel to numerous clinical laboratory sites for practical experience d. Perform moderately taxing continuous physical work, often requiring prolonged sitting or standing, over

several hours. e. Maneuver phlebotomy and culture acquisition equipment to safely collect valid laboratory samples. f. Possess finger and manual dexterity necessary to control laboratory equipment (i.e. pipettes, inoculating

loops, test tubes) and adjust instruments to perform laboratory procedures. g. Use a computer keyboard to operate laboratory instruments and to calculate, record, evaluate, and transmit

laboratory information.

3. Communication - Ability to communicate effectively in English using verbal, non-verbal and written formats with faculty, other students, clients, families and all members of the healthcare team.

a. Read and comprehend technical and professional materials (i.e. textbooks, magazine and journal articles, handbooks, and instruction manuals).

b. Follow verbal and written instructions in order to correctly and independently perform laboratory test procedures.

c. Clearly instruct patients prior to specimen collection. d. Effectively, confidentially, and sensitively converse with patients regarding laboratory tests. e. Communicate with faculty members, fellow students, staff, and other health care professionals verbally and

in a recorded format (writing, typing, graphics, or telecommunication). f. Transmit information to clients, fellow students, faculty/staff, and members of the healthcare team. g. Independently prepare papers, prepare laboratory reports, and take paper, computer, and laboratory

practical examinations.

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4. Intellectual - Ability to collect, interpret and integrate information and make decisions. a. Possess intellectual skills: comprehension, measurement, mathematical calculation, reasoning, integration,

analysis, comparison, self-expression, and criticism. b. Be able to exercise sufficient judgment to recognize and correct performance deviations. c. Apply knowledge to new situations and to problem solving scenarios.

5. Behavioral - Possess the emotional health and stability required for full utilization of the student’s intellectual

abilities, the exercise of professional judgment, the prompt completion of all academic and patient care responsibilities and the development of mature, sensitive and effective relationships with faculty, fellow students, clinical instructors, patients and other members of the healthcare team. a. Manage heavy academic schedules and deadlines. b. Be able to manage the use of time and be able to systemize actions in order to complete professional and

technical tasks within realistic constraints. c. Be able to manage the use of time and be able to systemize actions in order to complete professional and

technical tasks within realistic constraints. d. Possess the emotional health necessary to effectively employ intellect and exercise appropriate judgment

under conditions of physical and emotional stress. e. Be able to provide professional and technical services while experiencing the stresses of task-related

uncertainty (i.e. ambiguous test ordering, ambivalent test interpretation), emergent demands (i.e. "stat" test orders), and a distracting environment (i.e. high noise levels, crowding, complex visual stimuli).

f. Be flexible and creative and adapt to professional and technical change. g. Recognize potentially hazardous materials, equipment, and situations and proceed safely in order to

minimize risk of injury to patients, self, and nearby individuals. h. Adapt to working with unpleasant biological specimens. i. Support and promote the activities of fellow students and health care professionals. Promotion of peers

helps furnish a team approach to learning, task completion, problem solving, & patient care. j. Be honest, compassionate, ethical and responsible and accept responsibility and accountability for one’s

own actions. k. Be forthright about errors or uncertainty. l. Be able to critically evaluate his or her own performance, accept constructive criticism, and look for ways

to improve performance (i.e. participate in enriched educational activities). The student must be able to evaluate the performance of fellow students and tactfully offer constructive comments.

m. Works with Cultural Diversity: Works well with men and women and with a variety of ethnic, social, or educational backgrounds.

Adapted from: Fritsma, G.A., Fiorella B. J., and Murphey, M. Essential Requirements for Clinical Laboratory Science. CLS 1996. Vol. 9, pp 40-43

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FVCC Medical Laboratory Technology Program Essential Functions Verification Signature Form

Student Printed Name: ________________________________ Instructions: The Essential Function Verification signature form must be completed and submitted with the program application. I acknowledge that I have carefully reviewed the Medical Laboratory Technician Program Essential Functions. I am placing an “X” in front of the statement which reflects my ability to meet them. ☐ Yes ☐ No I can meet the technical standards and essential functions of the FVCC MLT Program as specified and do not require any reasonable accommodation to meet these requirements at this time. If you answered No to the question above: ☐ I require the following reasonable accommodation(s) to meet the technical standards and essential functions standard as specified: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________ _____________________________ Student Signature Date Accommodations for persons with disabilities can be provided upon request by calling the Disabled Student Services Office, at (406) 756-3881. Any qualified student with a disability who believes that an auxiliary aid is necessary for participation in any course activity or degree program is strongly urged to indicate a need for services to the Advocate for Students with Disabilities a minimum of six weeks prior to the beginning of the academic semester. This will provide sufficient time to assess student need and obtain any necessary auxiliary aid. For more information, please call (406) 756-3881 (voice or TTY). Inquiries concerning Title VI, Title IX and Section 504 may be referred to: Vice President of Instruction, Blake Hall, Rm. 136, 777 Grandview Drive, Kalispell, MT 59901, (406) 756-3894; or the Montana Human Rights Commission, 1236 Sixth Avenue, P.O. Box 1728, Helena, MT 59624, (406) 444-2884/1-800-542-0807

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FVCC MEDICAL LABORATORY TECHNOLOGY PROGRAM APPLICANT RECOMMENDATION FORM

Applicant Name___________________________________________ 1. In what capacity have you been able to observe the applicant’s attitude and personal behaviors? NOTE: Only

professional references allowed, no personal. ☐ Faculty ☐ Supervisor ☐ other, please describe ________________________ 2. How long have you known the applicant? ☐ Less than 6 months ☐ 6 months to 1 year ☐ 1 – 3 years ☐ 3 – 5 years ☐ Greater than 5 years 3. Based on your knowledge of applicant, using the following rating scale, please rate the applicant regarding: 4 – Outstanding 3 – Good 2 - Average 1 – Below Average

Attitude and Behaviors 4 3 2 1 a. Personal hygiene and attire appropriate to situation ☐ ☐ ☐ ☐ b. Demonstration of ethical and professional behaviors and/or demeanor ☐ ☐ ☐ ☐ c. Maturity ☐ ☐ ☐ ☐ d. Sense of Responsibility ☐ ☐ ☐ ☐ e. Demonstrates initiative ☐ ☐ ☐ ☐ f. Ability to manage stress ☐ ☐ ☐ ☐ g. Communication and interpersonal skills ☐ ☐ ☐ ☐ h. Motivation and enthusiasm ☐ ☐ ☐ ☐ i. Problem solving skills ☐ ☐ ☐ ☐ j. Acceptance of constructive criticism ☐ ☐ ☐ ☐ k. Potential for success in an intense, fast paced college program. ☐ ☐ ☐ ☐ l. Potential for success in a health care field. ☐ ☐ ☐ ☐ 4. Would you recommend this applicant for admission to the FVCC MLT Program?

☐ This applicant receives my highest recommendation. ☐ I recommend this applicant with reservations ☐ I recommend this applicant with confidence. ☐ I would not recommend this candidate ☐ I recommend this applicant.

5. Please use the following space or back of form for additional comments pertinent to applicant. All information

on this document is kept in strict confidence and will be accessible only to the MLT program faculty.

The applicant is required to turn in their professional recommendations with their FVCC MLT Program Application. You may scan and email the completed form to jalexand@fvcc.edu or fold the form and seal in a standard letter-size envelope, and sign across the seal before returning to the applicant.

Please print name _______________________________ Position or Title ________________________ Place of employment____________________________________________________________________ Telephone Number______________________________________________________________________ Signature____________________________________________ Date___________________________

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FVCC MEDICAL LABORATORY TECHNOLOGY PROGRAM APPLICANT RECOMMENDATION FORM

Applicant Name___________________________________________ 1. In what capacity have you been able to observe the applicant’s attitude and personal behaviors? NOTE: Only

professional references allowed, no personal. ☐ Faculty ☐ Supervisor ☐ other, please describe ________________________ 2. How long have you known the applicant? ☐ Less than 6 months ☐ 6 months to 1 year ☐ 1 – 3 years ☐ 3 – 5 years ☐ Greater than 5 years 3. Based on your knowledge of applicant, using the following rating scale, please rate the applicant regarding: 4 – Outstanding 3 – Good 2 - Average 1 – Below Average

Attitude and Behaviors 4 3 2 1 a. Personal hygiene and attire appropriate to situation ☐ ☐ ☐ ☐ b. Demonstration of ethical and professional behaviors and/or demeanor ☐ ☐ ☐ ☐ c. Maturity ☐ ☐ ☐ ☐ d. Sense of Responsibility ☐ ☐ ☐ ☐ e. Demonstrates initiative ☐ ☐ ☐ ☐ f. Ability to manage stress ☐ ☐ ☐ ☐ g. Communication and interpersonal skills ☐ ☐ ☐ ☐ h. Motivation and enthusiasm ☐ ☐ ☐ ☐ i. Problem solving skills ☐ ☐ ☐ ☐ j. Acceptance of constructive criticism ☐ ☐ ☐ ☐ k. Potential for success in an intense, fast paced college program. ☐ ☐ ☐ ☐ l. Potential for success in a health care field. ☐ ☐ ☐ ☐ 4. Would you recommend this applicant for admission to the FVCC MLT Program?

☐ This applicant receives my highest recommendation. ☐ I recommend this applicant with reservations ☐ I recommend this applicant with confidence. ☐ I would not recommend this candidate ☐ I recommend this applicant.

5. Please use the following space or back of form for additional comments pertinent to applicant. All information

on this document is kept in strict confidence and will be accessible only to the MLT program faculty.

The applicant is required to turn in their professional recommendations with their FVCC MLT Program Application. You may scan and email the completed form to jalexand@fvcc.edu or fold the form and seal in a standard letter-size envelope, and sign across the seal before returning to the applicant.

Please print name _______________________________ Position or Title ________________________ Place of employment____________________________________________________________________ Telephone Number______________________________________________________________________ Signature____________________________________________ Date__________________________