Organization Profile Form

Medical Laboratory Scientist (MLS) AMT
Organization Profile
Organization Name*
Campus Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Type*

UniversityOther
Accreditor (check all that apply)*

ABHESACCETACCSCCAAHEPNAACLSOther
Current Certification Agency Used (check all that apply)*

AMTASCPNoneOther
Website Address and/or Academic Program Links*
example: www.amt-university.org
Contact Info
Contact Name*

First NameLast Name
Title*
Business Email*
example@example.com
Phone Number*
Program Curriculum

As indicated in your organization's course catalog
Does the program award a Bachelor Degree?*

YesNo
Does the program include a clinical rotation as part of the curriculum?*

YesNo
Students complete a clinical rotation through the following sections of the laboratory:*

Blood BankingChemistryHematologyMicrobiology
Do your students complete a 52-week CLS training program separately?*

YesNo
Minimum Program Requirements

Check all areas below which apply to your curriculum
General Laboratory

Laboratory QualityLaws and RegulationsSafetyInstrumentation, Maintenance, Principals of OperationLaboratory MathematicsGeneral MicroscopyPhlebotomy and Specimen CollectionPatient IdentificationWaived Testing
Chemistry

General Knowledge & TerminologyInstrumentationRenal Function TestsHepatic Function TestsCarbohydrate MetabolismProtein AnalysisEnzymologyEndocrinologyLipidsWater and ElectrolytesAcid-Base BalanceCerebrospinal fluid (CSF)Other Chemistry Procedures
Hematology

General Knowledge & TerminologyErythrocyte ProceduresLeukocyte ProceduresThrombocyte ProceduresSpecial ProceduresAutomated Instrumentation
Coagulation and Hemostasis

General Knowledge & TerminologyCoagulation Procedures
Immunology and Serology

General Knowledge & TerminologyAnalytic ProceduresSerological Tests for SyphilisSpecial Procedures
Immunohematology

General Knowledge & TerminologyBlood TypingImmune ResponseCompatibility Testing Principles & ProceduresRh Immune GlobulinSpecial Tests
Blood Banking and Transfusion Services

General Knowledge & TerminologyBlood Banking Practices
Microbiology

General Knowledge & TerminologyBacteriologyMedia Quality Control, Techniques & CulturesBacterial IdentificationSpecial TestsVirologyParasitologyMycology
Urinalysis and Body Fluids

General Knowledge & TerminologyRenal FunctionUrinalysis ProceduresSpecial tests
Total Program Requirements Selected
By submitting this form, I am attesting to the accuracy of the information provided.
Agreement*

Clear
Please verify that you are human*
Account Care
example@example.com
N/A1

General Knowledge & TerminologyMycological identificationsMycological procedures
General Knowledge & TerminologyParasite identificationSpecial tests
N/A2

YesNo
N/A3
(If other)
N/A4
(if other)
Should be Empty:

Medical Laboratory Scientist (MLS) AMT

Organization Profile

Contact Info

Program Curriculum

Minimum Program Requirements