Medical Lab Technician Program Application

Please fill out the following form to apply to the Medical Lab Technician Program at Louisiana Delta Community College - Monroe.

Applicant Information
Full Name Full Name First Middle Last
Date of Birth Date of Birth / MM / DD YYYY
Cellphone Number Cellphone Number - ### - ### ####
Preferred Email
Please indicate your LDCC student status.
If you are a CURRENT LDCC student, please provide your L-number (student ID number):
Educational Background
Please select the highest level of education completed:
If you have a degree, please specify program of study:
Healthcare Experience
Please indicate your experience in a healthcare setting:

Please indicate your experience in a healthcare setting: Full-time Part-time Not at all
If applicable, please specify the position(s) you've held in a healthcare setting:
Previous Application History
Please indicate your previous application history.

Please indicate your previous application history. I have previously applied to the LDCC MLT Program. I have NOT previously applied to the LDCC MLT Program.
Healthcare Education and Certification
Do you currently have or have previously had a healthcare-related degree?
If you selected yes, please specify the degree:
Do you currently have or have previously had a healthcare-related certification?
If you selected yes, please specify the certification:
Personal Statement
Why have you selected the Medical Lab Technician Program?
What are you looking forward to gaining from this field of laboratory medicine?
How do you feel the program will be enhanced by having you in it?