Phlebotomy Program Interest Form

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address City State ZIP Code

Cell Phone Number(Required)

Home Phone Number

Work Phone Number

Email(Required)

Current or previous student at Davidson-Davie?(Required)

Upload of the Following Documents is Required for Admission

DOCUMENT 1: High school diploma or equivalent(Required)

Max. file size: 256 MB.

DOCUMENT 2: American Heart Association CPR certification(Required)

Max. file size: 256 MB.

Certification must be valid through the end of class

DOCUMENT 3: Provide proof of ONE of the following listed below

Max. file size: 256 MB.

OPTION 1) An official or unofficial high school transcript if a student graduated within the last 5 years and has an unweighted GPA of 2.6 or higher. | OPTION 2) SAT score report indicating a 480 or higher in Evidence-Based Reading and Writing. | OPTION 3) ACT score report of 22 or higher in Reading or 18 or more in English. | OPTION 4) Score at least 10.0 on the CASAS* reading placement test. | OPTION 5) An official or unofficial transcript indicating completion of a college-level English course.

*Students who need to take the CASAS reading placement test must first obtain a testing
permission form. Contact Eusebio Velez, eusebio_velez@davidsondavie.edu.