Phlebotomy Training Program Application Request Form 2010 by vng17747


									          Phlebotomy                               Application Deadline: March 26, 2010
                                                           SEATS ARE LIMITED
                                                                                                            Phlebotomy Training Program

       Training Program                            Fees:                                                    Application Request Form 2010
                                                   $35 non-refundable application processing fee.
                                                   $1200 Tuition Phlebotomy Program
                                                   (Includes Units 1-4)                               Name:_____________________________
                                                    $800 Stony Brook Students and Alumni -
Goal: To provide students with a working           “Seats are limited”.
knowledge of blood collection procedures,                                                             City:______________________________
techniques, equipment, specimen requirements       Refund policy available upon request               State:______ ZIP:___________________
and point of care testing. The course includes a
three week clinical rotation for the practice of    In addition, students completing the clinical     Daytime Phone:_____________________
phlebotomy.                                        portion of phlebotomy will be expected to pay a
                                                                                                      Cell Phone:            _____________________
                                                   nominal fee for their malpractice insurance. All
Unit 1 (May 24-28, 2010 consists of basic          students are required to have an updated           (This number will be used to contact you for an
anatomy and physiology, medical terms and          physical examination that complies with the
abbreviations and cardiopulmonary resuscita-       standards set forth by the School of Health        interview.)
tion (CPR).                                        Technology & Management. (Financial aid is         E-Mail Address:________________________
                                                   unavailable through the University.)
Units 2 and 3 (June 1-11, 2010) consist of a       COMPLETED physical examination must be
comprehensive background in theory and prin-       on record before start of class.
ciples of blood collection, including thirty                                                          ( ) Check if you are a Stony Brook Student
hours of laboratory practice for blood collec-     How to Apply:                                            or Alumni
tion procedures.                                      Please contact the School of Health
                                                      Technology and Management at (631) 444-
Unit 4 (June-July) involves placement in a            3925, or mail the attached request form for          Return application request form to:
clinical setting for 100-120 hours of phlebot-        an application packet.
omy practice for those students who success-
fully completed Units 1,2 and 3.                       Completed applications must be accompa-
                                                       nied by a non-refundable check or money            Department of Clinical Laboratory
The Phlebotomy Program consists of 60
hours Phlebotomy Lecture, 30 hours Labo-
                                                       order for $35 made payable to IFR #                            Sciences
                                                       910084. Applicants who have met the pro-
ratory Practice, and 100—120 hours of                  gram prerequisites will be invited for an           School of Health Technology &
Clinical Rotation.                                     interview.                                                   Management
Books and lab coats are purchased by the               When accepted to the program, a money                   Stony Brook University
student.                                               order or certified check for the program
                                                       will be due by May 3, 2010. Make check
                                                                                                            Stony Brook, NY 11794-8205
Following the successful completion of Units 1         payable to, “IFR # 910084”.                       Attn: Phlebotomy Training Program
-4, students will be eligible to take a national       PAYMENT MUST BE RECEIVED BY
certification examination for phlebotomy
                                                       MAY 3, 2010, OR YOUR SEAT WILL                      *   APPLICATION DEADLINE
                                                       BE FORFEITED.
                                                                                                                  MARCH 26, 2010
Accreditation:                                     Location:
American Society for Phlebotomy                    Classroom instruction will be held at the
Technicians (ASPT)                                                                                    Application will not be processed unless fee is included. The Divi-
                                                   Health Sciences Center at Stony Brook              sion of Diagnostic and Therapeutic Sciences reserves the right to
Program Prerequisites:                             University. Clinical instruction will be held      limit registration and cancel any course with insufficient registration.
                                                   at various clinical sites in Nassau and            Changes in day, hours or room assignments may be made when
   High school diploma or GED equivalent                                                              necessary.
   Eighteen years of age or older                  Suffolk Counties.                                  This form may be duplicated
   Minimum GPA of 80 on a scale of 100; 2.5 on                                                        Web Site Address:
   a scale of 4.0.
                                                                                                  PROGRAM INSTRUCTOR:

                                                                                                  Kathleen Finnegan, MS, MT(ASCP)SH, CPT
                                                                                                  Chair, Clinical Associate Professor
                                                     The Department of                            Clinical Laboratory Sciences Program
                                                                                                  Stony Brook University
                                                Clinical Laboratory Sciences
                                                           of the                                 DIRECTIONS TO
                                               School of Health Technology &                      HEALTH SCIENCES CENTER
                                                                                                  By car: Long Island Expressway (I-495) east to
                                                                   Presents                       exit 62N; follow Nicoll’s Road (Route 97) north
                                                                                                  for 9 miles. Entrance to Stony Brook University
                                                            A Program In                          Hospital Medical Center/Health Sciences Center
                                             Phlebotomy Training                                  is at the South Entrance, right onto East Loop
                                                                                                  Road. Visitors may park in the UH Garage
                                                                                                  which is to the left off East Loop Road for a fee
                                                  CLASSROOM INSTRUCTION:                          of $7.50 per day. Students accepted into the
                                                                                                  program will be eligible to pay a discounted fee
                                                   May 24 through June 11, 2010
                                                                                                  for parking. The main entrance to University
                                                     Monday through Friday
                                                                                                  Hospital is on Level 5. Information desk
                                                      9:00 a.m. to 4:00 p.m.
                                                                                                  personnel will direct you to the classroom in the
                                                     Health Sciences Center
                                                                                                  Health Sciences Center.
                                                     Stony Brook University
                                                    CLINICAL INSTRUCTION:
                                             Each student will be assigned three weeks of         By Train: The Long Island Rail Road (LIRR)
                                             phlebotomy practice during June and July.            Port Jefferson line to Stony Brook.
                                                                                                  University bus service to the Health Sciences
School of Health Technology & Management

                                             Hours to be determined by the clinical site.
Department of Clinical Laboratory Sciences

                                                                                                  Center is available on the campus side of the
                                                   Department of Clinical Laboratory Sciences     station.
                                                  Division of Diagnostic & Therapeutic Sciences
                                                  School of Health Technology & Management
                                                              Stony Brook University
Stony Brook, NY 11794-8205

                                                       Stony Brook, New York 11794-8205
                                                              TEL: (631) 444-3925                 The State University of New York at Stony Brook is an Equal Opportunity
                                                              FAX: (631) 444-8821                 and Affirmative Action educator/employer. If you are in need of a disability
Stony Brook University

                                                                                                  -related accommodation, please contact the Department of Clinical
                                                                                                  Laboratory Sciences at (631) 444-3925.

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