AMERICAN SOCIETY FOR CLINICAL LABORATORY SCIENCE - TENNESSEE
ASCLS-TN is the constituent state society of the national organization the American Society of
Clinical Laboratory Sciences, or ASCLS. As a proponent of the Medical Laboratory professions,
ASCLS-TN has decided to offer scholarships to outstanding and deserving students in the field.
Eligibility
Each applicant must be a permanent resident of the United States and be currently enrolled in a
NAACLS approved Medical Laboratory Science (MLS) or Medical Laboratory Technician
(MLT) program in the state of Tennessee. Applicant credentials are evaluated by a by an
impartial committee appointed by the President-Elect of ASLCS-TN and approved by the
ASCLS-TN Board of Directors. Only complete application packets will be considered.
Award
Two scholarships in the amount of $500 will be awarded. One $500 MLS Student Scholarship
and one $500 MLT student scholarship.
Criteria
The weight of the decision is divided evenly between the following criteria:
1) Scholastic Achievements
2) Personal Qualifications
3) Professional Promise
4) Financial Need
Application Packet
1.
Completed Application (attached).
2.
Resume - This should include work, education and volunteer experience, as well as
any honors, awards, & citations you have received. Please include your email address.
3.
Transcripts from all colleges attended - Official transcripts issued to the student are
acceptable.
4.
Two Letters of Recommendation – These references should be professional
references (such as a teacher or program director) AND must be accompanied by a
Performance Review Sheet (attached). They should be in sealed envelopes with the
signature of the recommender across the seal.
5.
A 500 word response to EACH of the essay questions.
6.
All applications must be postmarked by February 28th, 2017.
Application Process
Complete application packets should be submitted to:
Perry M. Scanlan ASCLS-TN President-Elect
4835 Saint Andrew Ct.
Clarksville, TN 37043
All complete applications will be reviewed and the awardees selected by committee. Winners
will be announced at TALC, the ASCLS-TN annual meeting in Nashville, TN May 3rd.
Visit the ASCLS-TN website for more information on the meeting: www.ascls-tn.org
ASCLS-TN Scholarship Application
Requirements for eligibility:
o Completed Application
o Resume
o Transcripts from all colleges attended (copies issued to the student are acceptable)
o Two Recommendations: Each to include a Performance review sheet and a letter of
support
o A 500 word response to EACH of the essay questions below
I. Applicant Information
Name:________________________________________ Phone: ___________________
Permanent Address: _____________________ City: ________ State: ___ Zip:________
Email:__________________________________________________________________
Name of School/University Laboratory Science Program: _________________________
Program Director: ______________________________ Phone: ___________________
Program Director Email:____________________________________________________
Address of Program: _____________________ City: ________ State: ___ Zip:_______
Type of Program (circle one):
MLS/CLS
MLT/CLT
Other:_____________
Anticipated Date of Graduation: _________ Student Status(circle): Full Time Part Time
II. Professional Organization Memberships:
ASCLS Membership #:_________ Date Joined: __________ Dues Paid Until: _______
Other Scientific Societies
Membership #
Dates of Membership
Offices Held
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
III. Essay Questions (attach answers using additional pages):
1) Why is receiving this scholarship important to you?
2) What do you want to contribute to the Medical Laboratory profession?
I hereby certify that all statements made herein and attached hereto are correct to the best of my knowledge. I
authorize the American Society for Clinical Laboratory Science – Tennessee Scholarship Committee to verify any
and all information given in connection with my application for this scholarship. I hereby release the Society, and all
persons connected with the Society, from any liability arising from solicitation or use of such information.
Signature: ____________________________________________ Date: _____________
AMERICAN SOCIETY FOR CLINICAL LABORATORY SCIENCE - TENNESSEE
MLS / MLT Student Scholarship
PERFORMANCE REVIEW SHEET
Name of Applicant: _____________________________________________________________________________
Name of Program Director/Teaching Supervisor/Graduate Advisor: ______________________________________
Mailing Address:
_____________________________________________________________________________
_____________________________________________________________________________________________
To Evaluator:
Please place a check in the appropriate space below. Standards used in ranking items 1-12 below
where comparisons are to be made with peers. Please return the Performance Review Sheet
with your letter of recommendation in a sealed envelope to the scholarship applicant to submit
with his / her application (please sign across the seal of the envelope).
1 – Outstanding top 5%
2 – Excellent next 10%, upper 15%
3 – Good next 20%, upper 35%
4 – Average middle 30%;
5 – Reservations next 30%, lower 35%
6 – Poor lower 5%
7 - No basis for judgment
FACTORS
1. Technical Knowledge/Skills - To what extent does s/he maintain a
satisfactory level of knowledge and/or technical skills?
2. Quality of Work - To what extent does her/his work meets the required
standards: i.e. accuracy, neatness and thoroughness?
3. Productivity - To what extent does s/he accomplish the quantity of work
expected of the job assignment?
4. Communication Skills - To what extent does s/he adequately prepare
and maintain written reports, correspondence and assignments?
5. Dependability - To what extent does s/he perform work without close
supervision or assistance?
6. Adaptability - To what extent does s/he adapt to new situations and
changes in routines, workload and/or work assignments?
7. Initiative - To what extent does s/he present new ideas or otherwise
demonstrate an awareness of need for change?
8. Attendance - To what extent does s/he maintain satisfactory attendance
in regard to tardiness, early departures, and/or absences?
9. Relations with Others - To what extent does s/he establish effective
working relations when dealing with supervisors, peers, and/or the public?
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2
3
4
5
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10. Perseverance - Stamina, endurance?
11. Self-confidence - Assuredness, capacity to achieve?
12. Intellectual Ability
Evaluator
Position
Date _________
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