Application Form

PSHMC School of Medical Laboratory Science Application

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Application Form

	Providence Sacred Heart Medical Center & Children's Hospital School of Medical Laboratory Science - Spokane, WA Please complete ALL information; at the end of the application, you will be directed to a secure website where you can pay the $50, non-refundable application fee with a credit card. Your application is not complete until payment is received.

1.	First Name:*

2.	Middle Name or Initial:* Enter none if not applicable.

3.	Last Name:*

4.	Maiden name and/or nickname:* If none, mark as NA.

	Please provide your residence information.

5.	Street address:*

6.	City:*

7.	State:*

8.	Zip code:*

9.	Country:*

10.	Email address:*

11.	Please enter your primary phone number.* Format should be (999) 999-9999

12.	I understand I am applying for the July 2025 12-month cohort.*

13.	If you are accepted into the program, can you provide proof of your right to live and work legally in the United States for the entire training program?*

14.	Are you 18 or older?*

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