Idaho State University Clinical Laboratory Science Program Application
* Required
Bengal Number (if not available, Date of Birth - mm/dd)
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Legal Name (Last, First, Middle Initial/Maiden name)
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Are you a permanent resident of Idaho?
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Yes
No
Email Address
Address
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City
*
State
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Zip
Telephone - Day
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Telephone - Home
Cell phone
Please consider this application for:
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Boise/Meridian only
Pocatello only
Boise/Meridian or Pocatello
Online with approved sponsorship with an ISU CLS clinical affiliate (Contact CLS Program Director)
Other:
Have you been accepted to ISU? (If no, please be sure to apply to ISU)
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Yes
No
I am interested in the
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BS in CLS (first degree)
BS in CLS (second degree)
MS in CLS (Route 1)
MS in CLS (Route 2)
Other:
Cumulative GPA
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Have you completed all required prerequisite coursework?
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Yes
No (if no is checked, please describe how are you planning on completing in the academic background section)
I am not sure, I would like to make an appointment with an advisor
Academic Background
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Please indicate dates, places of attendance, and degree(s) granted
Have you ever been convicted of or have pending against you a felony or misdemeanor other than minor traffic violations
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Yes (if yes is checked, please contact CLS Program Director to ensure your eligibility for future employment)
No
Are you being sponsored by a hospital, clinic, or other institution?
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Yes
No
If yes, please indicate the name and address of the Sponsoring organization and the contact name, telephone number and email address
Please list the names, telephone number and email addresses of the three references from which you have requested recommendations:
How did you hear about the ISU CLS Program?
ISU Catalog
ISU CLS Website
Friend
Graduate of CLS Program
Employer
Other:
Applications missing any of the following documents listed below will be considered incomplete and will not be evaluated for acceptance
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I have completed the online CLS application
I have contacted three references that have indicated that they will submit a reference form on my behalf
I have adequate computer access and fluency as indicated in CLS website
I have submitted a short essay stating reasons for my selection to clinical laboratory science as a career as well as my professional goals
I have read the essential information on the CLS website and agree with it
I have scheduled an appointment or have met with the CLS Program Director or other CLS faculty member for advisement prior to the start of the fall semester classes
I will provide appropriate vaccination documentation as requested