Application for Admission to VSL Nursing & Allied Health Programs

Program Applying for:*

Train the TrainerCertified Nursing Assistant (CNA)Electrocardiograph Technician (ECG)Medical AssistantSterile Processing RefresherPhlebotomy RefresherOphthalmic AssistantPharmacy Technician

Have you taken the TABE?

YesNo

What was your TABE Score? (Enter number 1-10)

Please submit your TABE test results.*

You must have taken the TABE and score at least a NRS 4 or higher to continue with the application. Please contact Mrs. Eve Anderson for remediation at Eve.Anderson@fletcher.edu or 985-448-5926.

Which semester are you applying for?*

FallSpringSummer

When would you prefer your labs?*

DayEvening

Are you currently enrolled in an Adult Education Program at Fletcher or Bayou Cane Adult Ed?*

YesNo

Name*

First NameLast Name

Please list all previous names/aliases*

Type N/A if not applicable

Fletcher Student ID (LoLA Number):*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (cell)*

Please enter a valid phone number.

Email*

example@example.com

Birth date*

Date

Applicants must possess a high school diploma or equivalency to apply to this program. Please input date high school diploma or equivalency was awarded*

Ex. 05/1996

Are you presently a student at Fletcher?*

YesNo

Are you a LCTCS employee?*

YesNo

Are you currently employed as a Sterile Processing Technician?*

YesNo

Are you currently employed as a Phlebotomist?*

YesNo

If yes, where are you employed?*

If no, have you met the required 400 hours of experiencing in an SPD in the last 5 years?*

YesNo

Have you met one of the following requirements below?*

1 year of supervised work experience in a phlebotomy technician field within the last 3 years (this work experience must include successfully performing a minimum of 30 venipuncture and 10 capillary sticks on live individuals)2 years of supervised work experience in a phlebotomy technician field within the last 5 years (this work experience must include successfully performing a minimum of 30 venipuncture and 10 capillary sticks on live individuals)

Calculation

Background Checks:

Background checks are required for the following programs:

Nurse Assistant
Medical Assistant
Electrocardiograph Technician (ECG)
Ophthalmic Assistant

Click here to submit your background check.

Instructions:

Click here for Instructions

I acknowledge my application is not completed and cannot be considered for admission into the program until my background check is received.

I understand that once I am registered for the class/program, I will be responsible for tuition and fees assessed. I also understand that tuition and fees for these classes/programs are nonrefundable unless the college cancels the class/program.

If I receive funding from an outside source and that funding is discontinued before the full amount is paid, I understand that I am responsible for paying the remaining balance. Additionally, I acknowledge that if I withdraw from, am dismissed from, or am unsuccessful in the class/program, my eligibility for continued outside funding may be affected, and I will be responsible for paying any remaining balance.

Train the Trainer*

USDTrain the Trainer

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration