Application

This application will take about an hour to complete.

Personal Information:

Last Name: First Name: Middle Initial:


Current Address:
Street:
City:
 State: Zip:
Current Phone:
E-mail Address:


Permanent Address: check box if same as above
Street:
City:
 State: Zip:
Permanent Phone:

How were you referred to the School of Cytotechnology?
Friend

Relative

 Advisor Other:

Educational History

High School:

Location:
Dates attended (mm/yy):

Major Study
Diploma or Degree?

 
Vocational/Tech School:

Location:

Dates attended
(mm/yy):

Credits
Earned:

Major Study

Diploma or Degree?

 

 

University/College:

Location:

Dates attended
(mm/yy):

Credits
Earned:

Major Study

Diploma or Degree?

 

 

Additional Universities:

Location:

Dates attended
(mm/yy):

Credits
Earned:

Major Study

Diploma or Degree?

 

 

Graduate School:

Location:
Dates attended
(mm/yy):

Credits
Earned:

Major Study

Diploma or Degree?

 

 

Other (specify):

Location:

Dates attended
(mm/yy):

Credits
Earned:

Major Study

Diploma or Degree?

Please list awards, honors, research papers, etc.

Employment History:

Employer 1:

Type of Business

Address:
Street:
City:
 State: Zip:
Current Phone:
Job Title/Duties:
Start Date: End Date:

 

Employer 2:

Type of Business

Address:
Street:
City:
 State: Zip:
Current Phone:
Job Title/Duties:
Start Date: End Date:

 

Employer 3:

Type of Business

Address:
Street:
City:
 State: Zip:
Current Phone:
Job Title/Duties:
Start Date: End Date:

Describe your interest in cytotechnology.

Please limit your essay to one page.

You may also email your essay, with your name in the subject line, to: cytotechschool@mail.slh.wisc.edu

Academic/Professional References

Name of Reference 1:

Title/Occupation:

Address:
Street:
City:
 State: Zip:
Current Phone:

 

Name of Reference 2:

Title/Occupation:

Address:
Street:
City:
 State: Zip:
Current Phone:

 

 

Name of Reference 3:

Title/Occupation:

Address:
Street:
City:
 State: Zip:
Current Phone:

 

Note:

An official college transcript and a $25.00 application fee are required to complete your application, as well as a personal interview at the school.


To set up an appointment for your interview, call, write, or e-mail :

School of Cytotechnology
State Laboratory of Hygiene 465 Henry Mall
Madison, WI 53706-1578
(608) 262-2802
e-mail: cytotechschool@mail.slh.wisc.edu

 

This institution, in compliance with Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972, does not discriminate on the basis of race, color, national origin or sex in any of its policies, practices or procedures. This includes, but is not limited to, admissions, employment, financial aid, or educational services.