Organization Profile Form

Medical Laboratory Technician (MLT) AMT
Organization Profile
Organization Name*
Campus Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Type*

High SchoolCommunity CollegeCareer SchoolTechnicalUniversity
High School Affiliate*
Name of Partnered Organization
Accreditor (check all that apply)*

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

AMTASCPNCCTNHANoneOther
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 an Associate 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
Minimum Program Requirements

Check all areas below which apply to your curriculum
General Laboratory

Laboratory QualityLaws and RegulationsLaboratory SafetyInstrumentation, Maintenance, Principals of OperationLaboratory MathematicsGeneral MicroscopyPhlebotomy & Specimen CollectionSpecimen Integrity/HandlingPatient IdentificationWaived Testing
Chemistry

General Knowledge & TerminologyInstrumentation: parts, operation, maintenanceRenal Function TestsHepatic Function TestsCarbohydrate MetabolismProtein AnalysisEnzymologyEndocrinologyLipidsWater and ElectrolytesAcid-Based 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 & TerminologySerological Tests for SyphilisAnalytic ProceduresSpecial Tests
Immunohematology

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

General Knowledge & TerminologyBlood Banking Practices
Microbiology

General Knowledge & TerminologyBacteriologyMedia Quality Control, Techniques & CulturesBacterial IdentificationSpecial TestsVirologyParasitologyMycology
Urinalysis & 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
Does the program include laboratory experience as part of the curriculum?

YesNo
Parasitology

General Knowledge & TerminologyParasite identificationSpecial tests
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Medical Laboratory Technician (MLT) AMT

Organization Profile

Contact Info

Program Curriculum

Minimum Program Requirements