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Get Clinical Year Application - Andrews University

On Drive, Halenz Hall 326 Berrien Springs, MI 49104-0400 Phone: 269-471-3336 Fax: 269-471-6218 Department Use ONLY Date received: Name (please print) Soc. Sec. No. Permanent Address Current Address Phone Cell Phone E-mail Address Name of Parent or Guardian (if under 24) Phone Address Do you have any physical handicaps which would limit your work as a Medical Laboratory Scientist? o Yes o No Are you color Blind? If yes, please explain Have you ever been convicted of a felony? o.

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