Get Phlebotomy Application & Registration Form - Klamathcc

Completing the Phlebotomy Application & Registration Form online at Klamath Community College is a straightforward process. This guide will walk you through each section of the form, ensuring you provide all the necessary information accurately and efficiently.

Follow the steps to fill out your application form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide your full legal name in the designated fields (last name, first name, middle name).
3. Enter your primary phone number and email address in the respective fields to ensure effective communication.
4. Fill out your mailing address, including line 1, line 2, city, state, and zip code.
5. Indicate your date of birth in the format MM/DD/YYYY and select your gender from the options provided.
6. Select your marital status and indicate your ethnicity by checking the appropriate box.
7. Check all applicable race categories that apply to you.
8. Enter your social security number if applying for Federal Financial Aid; otherwise, this field may be left blank.
9. Choose your preferred payment option by checking the appropriate box (enclosed check, enclosed cash, or credit card).
10. If using a credit card, provide the credit card number, expiration date, and name as it appears on the card, selecting the card type.
11. Read the certification statement carefully, then type your printed name and provide your signature to confirm your information is accurate and that you consent to the necessary terms.
12. Finally, review all entries for accuracy. Save changes, then download or print the completed form for submission.

Complete your Phlebotomy Application & Registration Form online today to start your journey in the phlebotomy program!