Medical Lab Technician Information Request
Name
*
First Name
Last Name
Student ID #
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about the MLT Program?
*
Otero Website
E-mail
College Fair
HS Counselor
Newspaper
Radio Ad
TV Ad
Current Student
Other
Have you completed any college credits? If so, please list below.
Submit
Should be Empty: