Phlebotomy Application

The application for the Phlebotomy Program is included below. Please click on and follow the instructions for completing the form. Currently, the only way an application for the program is accepted is on-line. If you have any questions, please contact phlebotomy@cscc.edu.

Phlebotomy Application

Personal Information

First Name

Mid Initial

Last Name

Email Address

Please use your CSCC email address if you are a student.

Phone Number

Cougar ID Number

Home Address

City

State

Zip Code

County

Please list ALL progress on pre-admission courses:

If courses were completed at another college/university, make sure your transcript is on file in Columbus State's Records and Registration Department. All completed courses require a grade of "C" or better.

Placement in ENGL 1100

Placement in "No Reading Required"

Completion of Background Check and Drug Screening

Completed Health Record on file in Union Hall 134A (Must be completed ASAP)

Have you completed Mult 1110, Medical Terminology?

Have you completed your Information Session?

Current Laboratory Student Member of ASCP

Free membership at: https://www.ascp.org/content/membership/become-a-member

Do you understand the COVID-19 Vaccine is now a required part of the completed Health Records for the phlebotomy certificate program?

Written Statement of Interest and Intent

Write a brief (~ 30-word) statement explaining your interest in the Phlebotomy Program and your career goals:

Academics Department

(614) 287-0000

academics@cscc.edu

Phlebotomy Application

Phlebotomy Application

Department Contact