|
Application for ASCLS-PA |
|
Deadline for 2007-2008 is February 15, 2008 |
| Print, complete, and mail this
application to the Chair of the Continuing Education Committee Pasty Bering 4000 Gypsy Lane # 342 Philadelphia, PA 19129-5424 |
| Name:
______________________________________________________________________ |
| Address:
______________________________________________________________________________________ ______________________________________________________________________________________ |
| ASCLS Member #:
_____________________ |
|
NAACLS-PA Accredited Program |
| Name of Institution:
____________________________________________________________ |
| Address:
______________________________________________________________________________________ ______________________________________________________________________________________ |
| Expected month and year of
graduation: __________________________ |
| Program Director:
___________________________________ Phone #:
________________________________ |
|
Academic
Performance |
| CUM GPA _________ Dean's List (List Semesters): ___________________________________________ |
| Applicant Signature: _____________________________________________ Date: _______________________ |
ASCLS-PA Memorial
Scholarship Guidelines |
ASCLS-PA Home
Page |