Application for Admission

Old Dominion University
Medical Laboratory Science Program
(Deadline for the traditional program: February 1. Applicants for degree completion program accepted during the Fall or Spring semester.)

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Date Date * / MM / DD YYYY
Choose the program you are applying for:
Name Name * First Middle Last
UIN#
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mailing Address (If different from above) Mailing Address (If different from above)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Telephone Number Home Telephone Number - ### - ### ####
Cell Telephone Number Cell Telephone Number - ### - ### ####
Email
Please list the names and addresses of all colleges/universities attended in the space below (including ODU). Submit official transcripts to ODU Admissions. Additionally, please provide unofficial copies of all non-ODU transcripts directly to the MLS Program director via rchilds@odu.edu
Alternatively, you may mail unofficial transcripts to:

Old Dominion University
College of Health Sciences
Program Director, Medical Laboratory Science, Room 2118
4608 Hampton Blvd.
Norfolk, VA 23529
College/University
Address
Major
Dates Attended
List Additional Colleges/Universities, Degrees, Dates Attended: