Certificate Program Scholarship Form

Certificate Program Scholarship

One scholarship is available. To be eligible for the ASCLS-WA Certificate Program Scholarship (up to $1,000) you must be accepted into a certificate program and willingly provide one year of service to ASCLS-WA following completion of the program. Programs such as ASCLS Emerging Laboratory Managers Collaborative Conference (ELMC2), the UW Certificate Program in Clinical Laboratory Leadership and Management, Certificate Program in Clinical Laboratory Leadership and Management or the Edmonds College Integrated Healthcare Management- BAS are eligible for this scholarship. This scholarship is only available to ASCLS members.
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Email
example@example.com
ASCLS member number
Why did you enroll in the program, what are your goals after completion, and what do you anticipate the program will offer toward achievement of your goals? Please write a brief explanation addressing the above questions.
This scholarship is for up to $1000. Please upload any documentation that shows your cost for the program.

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Submit a copy of your documentation for the above program (required):*

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Applicant's certification:

My sincere intention at this time is to complete a certificate program. In the event that I do not complete the program, I understand that the scholarship will become a loan subject to repayment to the American Society for Clinical Laboratory Science-WA.
This application and documentation for a program must all be complete and received by July 5, 2025.
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Please send an email to Brenda Kochis when you have completed this form. Email is BrenKoch@comcast.net. This will ensure that we process your application as soon as possible.
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