2024 ASCLS-WA Student Scholarship Form

Student Scholarship Application

ASCLS-Washington offers two Student Scholarships of $1500.00 each. Applicant must be accepted to one the accredited programs of study. The application opens November 1, 2024 and closes on December 31, 2024 after which time the applicants will be evaluated. Successful applicants must be a member of ASCLS and will be expected to become involved in ASCLS-WA.
Name

First NameLast Name
Address

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CityState / Province

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Phone Number

Area CodePhone Number
Email
example@example.com
ASCLS member number
To apply for the ASCLS-WA Student Scholarship, you must be accepted to one of the following accredited programs of study. Check one:

Clinical Laboratory Technicial (CLT) or Medical Laboratory Technician (MLT)Clinical Laboratory Scientist ( CLS) or Medical Technologist (MT)CytologyHistology
Name of School
Program Director Name
Dates for Program
The requirement is that the student be in a current program. This request is for the dates that you are expected to be in the program.
Describe briefly any pertinent information concerning your financial situation that would be helpful in assessing your financial need.
Essay

Write a short essay including reasons for your choice of majoring in Clinical Laboratory Science or its specialties and your future goals. Include your opinions on Professional Societies and their role in your future.
Essay

0/300
Applicant's certification:

To the best of my knowledge, the information reported in this application is complete and accurate. My sincere intention at this time is to complete training in a CAHEA-approved school and to take the ASCP certification examination. In the event I leave the field of clinical laboratory science before passing one of the above exams, I understand the scholarship will become a loan subject to repayment to the American Society for Clinical Laboratory Science-WA.
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If you have any questions, please contact Brenda Kochis. Email is BrenKoch@comcast.net. We will process your application as quickly as possible.
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Student Scholarship Application