Application – Phlebotomy Institute of PA

Application Form

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Is student at least 18 years of age? *

Diploma/ GED received from:

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A $150 fee is required to submit an application. Enter your credit card information below.

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Please read the enrollment requirements below and then check the signature box below to agree to these terms.

Application Fee

Price: $ 150.00

Total

$ 0.00

Signature *

Sign application by checking this box. Information provided is self-attestations, to be verified at a later date. Enrollment agreement will be provided separate of this application.

Enrollment Requirements

Several items are required to successfully enroll in the phlebotomy program and ultimately be invited to sit for the final course examination. This document is to provide those requirements to you in an open format to allow you the opportunity to review these requirements; ask any questions that you may have; and be able to make decisions effectively for an enjoyable and effective educational experience. Please direct any questions to our staff at phone (814-571-3683) or email (phlebotomy@centrelifelink.com)

Initial requirements:

Submit completed application
Please scan and email proof of high school graduation or GED completion to phlebotomy@centrelifelink.com
Remit application fee: $150.00 (check or money order, please no cash)

If your application is accepted, we will send you a letter of acceptance with instructions on additional requirements needed prior to the start of the program.

Requirements prior to starting program:

Read, sign and return the Enrollment Agreement as provided by the Institute
Pennsylvania State Police Background clearance free of felony convictions
FBI Criminal Background clearance free of felony convictions
Department of Welfare background clearance
Submit verification of required vaccinations

- COVID-19
- Rubella
- Rubeola (Measles)
- Varicella (chickenpox)
- Mumps
- Tuberculin (TB) skin test
- Seasonal Flu

6. Provide proof of current certification in American Heart Association (AHA) Basic Life Support (BLS) CPR

- Only AHA BLS CPR can be accepted

7. Submit verification of High School graduation or GED completion

8. Submission of required tuition deposit 30 days prior to beginning of class

Requirements to Complete Course

Must satisfy all financial obligations to Phlebotomy Institute Of Central PA.
Must attend at least 36 class room hours to be eligible for the Clinical externship.
Must obtain minimum grade average of 70%, which includes classroom instruction, and clinical internship to demonstrate knowledge and competency. Grades are actual percentages of scores on exams. Overall course grade will be the average of:

Average score of 4 quizzes
Written mid-term test
Written final test
Practical exam

4. Successfully complete externship (40 hours of externship). All aspects of externship must be completed within 180 days of starting program.

Specific information regarding obtaining the required background clearances will be provided after successful acceptance to the program. Please do not start obtaining these items until such time.

By signing below I indicate that I have been provided the information contained on page 2 and page 3. I have read each item, comprehend each point, and have made my questions known if applicable. I further declare that I am fully aware of these requirements and understand the requirements set forth.