UND Cytotechnology Online Application
  Click here to display the instructions.
Date:
   
Full Name:  
Last Name:
First Name:
Middle Initial:
Email Adress:
   
Current Address:  
Street Address:
City:
State:
Zip:
   
Permanent Address:  
Street Address:
City:
State:
Zip:
   
Phone Numbers:  
Permanent Phone:
Ext:
Current Phone:
 Ext.:
Work Phone:
 Ext.:
   
College and Universities Attended (please begin with the current or most recent):
Location:
Major:
Degree:
Years Attended:
 From: To:
 
Location:
Major:
Degree:
Years Attended:
 From: To:
 
Location:
Major:
Degree:
Years Attended:
 From: To:
 
Total Semester Hours Completed in:
Bio Science Courses:
(excluding botany or
horticulture)
(miniumum of 20 semester hours)
Chemistry Courses:
 (minimum of 8 semester hours)
Mathematics Courses:
 (minimum of 3 semester hours)
Total College Semester
Hours:
Cumulative GPA:
   
Courses Planned or Underway:
Are you seeking a Bachelor
of Science degree in
Cytotechnology?
   
Please list to whom the Reference Questionnaires have been sent: Click here for a copy of the reference form. You must have Adobe Acrobat reader to open the document. Click here to get Adobe Acrobat reader.
1. Name
Occupation:
Street Address:
City
State
Zip
 
2. Name
Occupation:
Street Address:
City
State
Zip
 
3. Name
Occupation:
Street Address:
City
State
Zip
   
Have you previously worked in a health care institution? If yes, in what capacity?
   
Where did you hear about cytotechnology?
   
Submit a rationale statement for applying to the Cytotechnology Program and incorporate information pertaining to the questions listed below into your statement.

1. What are some of the aspects of cytotechnology as a profession that have stimulated your interest in becoming a cytotechnologist?
2. What do you envision are the responsibilities of an individual in the health care professions and how do these responsibilities apply to cytotechnology?
3. What are your goals in life? How will being a cytotechnologist help you obtain these goals?
4. What do you perceive to be the demands of the cytotechnology program and how do you see yourself dealing with these demands?
5. What are some personal traits or characteristics that you have that you feel are pertinent to becoming an  effective Cytotechnologist?

*You are not done upon submission of the form. Click here to go to the Application Instructions.