Medical Lab Technology Acknowledgements Form

Medical Laboratory Technology
Please read each statement carefully. This document contains important information regarding your selected program of study, and expectations within the career field. Please initial each statement, acknowledging that you have read and understand what to expect within this career field.
I understand that this program is rigorous and requires extensive reading, dedicated study time and time management skills.*
Initial
I understand it is recommended that students are not employed, or they work 20 hours or less while enrolled in this program.*
Initial
Seniors participate in clinical rotations on Tuesdays, Wednesdays, and Thursdays, up to 24 hours per week; in addition to taking an online course, (days and times are subject to change).*
Initial
I understand that the clinical environment can be stressful and I will be required to interact with blood, urine, sputum, feces, spinal fluid and tissue, as well as complex instruments and microscopes.*
Initial
I understand that I will be required to draw blood from patients.*
Initial
I understand that I should have an interest in science, good communication skills, critical thinking and decision-making skills, and a flexible and responsible demeanor.*
Initial
I understand all MLT courses must be completed with a grade of “C” or better and I must maintain a 2.0 GPA in order to remain in the program.*
Initial
I understand a criminal background check and drug screen will be required for entry into the clinical facility for my program*
Initial
I understand I will be required to take an exam after I graduate in order to be certified in my profession.*
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I understand continuing education will be required once I am a professional in my field.*
Initial
What can I expect after graduation?
(Initial each statement)
I understand that I will be exposed to different types of diseases such as AIDS, Hepatitis, and Tuberculosis. *
I understand that I will be required to interact with patients and draw blood.*
Name*

First NameMiddle NameLast Name
Student ID#*
Date*

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Electronic Signature*

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STATEMENT OF UNDERSTANDING REQUIREMENT FOR BACKGROUND CHECKS, DRUG SCREENS, AND VACCINES.
Admission to the Health and Human Services programs does not guarantee acceptance into a clinical rotation at an affiliate health care facility, which is required for graduation. Affiliate clinical sites supporting Health and Human Services programs require that students have background checks, and drug screens, and a completed York Technical College Health Form prior to acceptance or placement in clinical rotations. Random and discretionary background be done at the checks and drug screens may also be conducted at the request of the clinical site. These checks will be at the expense of the student.

Results of background checks and drug screens, physical exams, immunization records, titers, and 2-step PPDs will be reviewed with designated personnel at the affiliate clinical site. To be accepted for a clinical placement, all findings must be satisfactory to all participating clinical sites. Students not accepted for clinical rotations will not be able to successfully complete the course or program.

Students must be eligible to participate in all clinical sites affiliated with their particular program of study. Certain clinical sites have vaccine requirements, including the COVID-19 vaccine. Clinical sites can implement or modify vaccine requirements while a student is pursuing their studies and students will be required to comply with any updates in order to participate in clinical rotations and complete their program.

I understand that I must comply with the above requirements for a completed York Technical College Health Form, background checks, drug screens, and vaccine requirements as a student in the Health and Human Services programs.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Student E-Signature*

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VERIFICATION OF RECEIPT – HHS APPLICATION PROCEDURES
In signing below, I understand that it is my responsibility to read and comprehend the information about applying, qualifying for, and entering my goal program which is available at http://www.yorktech.edu/departments/hhsd.

I also understand that it is my responsibility to contact a Program Representative, Admissions Counselor, or an Advisor in the Academic & Career Advising Center for assistance should I have any questions regarding information about the academic program or within this form.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Student E- Signature*

Clear
Should be Empty:

Medical Laboratory Technology

STATEMENT OF UNDERSTANDING REQUIREMENT FOR BACKGROUND CHECKS, DRUG SCREENS, AND VACCINES.

VERIFICATION OF RECEIPT – HHS APPLICATION PROCEDURES