Gateway to Medical Laboratory Technician Careers Program

The Gateway to Medical Laboratory Technician Careers program is an 8-week program that will train participants to prepare them for entry into the ICC Medical Laboratory Technician associate degree program. Program participants will receive academic and skills development training to prepare them for the STEM degree program and a career as a Medical Laboratory Technician. In addition, the Greater Peoria Essential Abilities and Knowledge (GPEAK) certification system will be integrated throughout the bridge program.

If you are interested in the Gateway to Medical Laboratory Technician Careers program, please complete the interest form below. The program will target high school or GED graduates that are unemployed, underemployed, and underrepresented adults.

First Name *

Last Name *

Email *

Phone *

Alternate Phone

Street Address *

Apartment, Building or Suite

City *

State *

Zip Code *

Date of Birth *

Gender *

Self Describe *

Please indicate your primary ethnic/racial group *

Are you currently eligible to work in the U.S.? *

Yes

Disability Status *

For reasonable accommodations in accordance with the Americans with Disabilities Act, contact Access Services at (309) 694-5749. The office is located at the East Peoria Campus room L220D. Information provided will be kept confidential in accordance with the Family Educational Rights and Privacy Act of 1974 (P.L. 93-380).

Veteran Status *

I am a protected veteran

I am not a protected veteran

I do not want to disclose veteran status

Other Income Explanation *

Household/Family Size *

Used to determine income eligibility

Household Income *

Are you currently enrolled at ICC? *

Yes

Have you previously attended ICC? *

Yes

Level of education *

Classes may occur on campus in East Peoria, Peoria, and/or Pekin. Do you have reliable transportation? (lack of transportation will NOT exclude you from receiving benefits) *

Yes

Acknowledgement *

I certify the above information is correct to the best of my knowledge. I understand that this information is being provided as a matter of record; it will be kept strictly confidential. I authorize this program to obtain copies of my transcripts, test scores, financial aid awards, and other materials necessary for participation in the program. I will also grant permission for my photograph, photographic image, and/or video recorded image to be published in materials such as newsletters, annual reports, recruiting presentations, web pages, e-Profiles, etc., and release this program from any liabilities.

Yes, I certify