Dear Applicant,
The Medical Laboratory Science (MLS) Program at The George Washington University (GW) offers a
unique blend of online coursework combined with clinical instruction in accredited clinical laboratories.
Upon completion of the didactic portion of the MLS program, the students will be trained in those clinical
areas that fulfill their program requirements. The clinical educational experience consists of advanced
clinical courses (practica) in specific areas of the medical laboratory. Each practicum will vary in length
depending on the area of clinical specialty:
PRACTICUM COURSE NAME
Clinical Biochemistry
Clinical Microbiology
Blood Bank
Hematology and Hemostasis
Clinical Immunology and Serology
Urinalysis and Body Fluids
LENGTH
(WEEKS)
4
4
3
3
1
1
REQUIRED IN THESE PROGRAMS
BSHS, post-baccalaureate MLS and Chemistry Certificates
BSHS, post-baccalaureate MLS and Microbiology Certificates
BSHS, post-baccalaureate MLS and Blood Bank Certificates
BSHS, post-baccalaureate MLS and Hematology Certificates
BSHS, post-baccalaureate MLS and Blood Bank Certificates
BSHS, post-baccalaureate MLS
Applicants who live IN the Washington, DC metro area will have the opportunity to attend clinical training
at one of our four locally affiliated clinical sites. Local applicants only need to submit the Clinical Site
Verification (CSV). Your application will not be reviewed until the form is received.
Applicants residing OUTSIDE the Washington, DC area must be able to identify an acceptable accredited
(TJC and/or CAP) clinical laboratory willing to provide the clinical instruction in their area. In addition, the
applicant must initiate a facility review process between the proposed clinical facility and the GW MLS
program. The purpose of this facility review is to ensure that the student will have an acceptable clinical site
for the clinical portion of the program. Non-local applicants need to submit two forms: the Clinical Site
Verification (CSV) AND the Clinical Facility Fact Sheet. Your application will not be reviewed until
the forms are received.
Read the following information to complete this process:


All applicants must complete the CSV form that follows this letter. Be sure to indicate your
clinical site option (Options 1, 2, 3) on that document and return the form to the GW MLS
clinical coordinator as soon as possible.
Those applicants selecting Option 2 must begin the facility review process by contacting the
laboratory manager or clinical coordinator at the facility where they wish to complete
clinical rotations. These students should provide the MLS Letter of Introduction and CFFS to
the proposed clinical facility coordinator. After the CFFS is completed, the student should then
return the CFFS to the GW MLS program as soon as possible. This document will be reviewed
along with your online-submitted application and is critical to ensure that an assessment can be
made to determine if the selected site will meet program requirements. Unfortunately, students
who do not have an acceptable site are not eligible for admission; therefore, registration will be
withheld if the CFFS is not received prior to the GW semester start date.

The signed forms should be returned to:
Carol Rentas
Medical Laboratory Sciences Program
Clinical Research and Leadership Department
The George Washington University
2100 W. Pennsylvania Avenue, NW , Suite 5160
Washington, DC 20037
Or e-mailed to: carentas@gwu.edu
CLINICAL SITE VERIFICATION FORM
Name:
_______________________________________________________________
Address:
_______________________________________________________________
Phone:
_____________________
Email: _________________________________
Program (circle one): BSHS | Post-Bacc MLS | Hematology | Microbiology | Chemistry | Blood Bank
Please indicate your preferred clinical site option by initialing beside one of the choices below.
Option 1: I live in or around Washington, DC at the time of admission and do not need to find a
clinical site since GW is currently affiliated with four hospital laboratories in the Washington, DC
metro area. I understand local students will be placed in one of these clinical sites to complete their
practica. Initial here: _________
Option 2: I live outside of the Washington, DC area and am currently working on securing a
clinical site in my geographic area. This institution must be an acceptable accredited (TJC and/or
CAP) clinical laboratory willing to provide appropriate clinical instruction. To ensure that an
assessment can be made to determine if my selected site will meet program requirements, I understand
that I must contact the laboratory manager or clinical coordinator at the facility where I wish
to complete clinical experiences and ensure that they complete the facility fact sheet. I will
then return this form along with the clinical enrollment form to the GW MLS clinical coordinator.
Initial here: _________
Clinical Facility (name/location): ____________________________________________
Option 3: (military applicants only) I am a member of the United States Armed Forces on active
duty and presently deployed overseas. I do not have an available, local clinical site identified to
complete the clinical laboratory practicum courses, which are a part of the MLS program
requirements. I am currently working on securing a clinical site and will submit the clinical site
facility fact sheet as soon as possible. I understand that a delay in submitting the clinical facility
fact sheet may delay the start of the clinical portion of the program, potentially delaying or
prohibiting my ability to graduate. Initial here: _________
Overseas Assignment Location:_____________________________________________
Dear Laboratory Manager/Clinical Coordinator,
The Medical Laboratory Science Program at The George Washington University offers certificate and
bachelor’s degree programs to individuals interested in pursuing a career in the clinical laboratory. Our
program is a unique blend of online coursework combined with clinical instruction in accredited clinical
laboratories. Applicants residing outside the Washington, DC area who wish to complete the clinical
practicums in their area of residence must be able to identify an acceptable clinical laboratory willing to
provide the clinical instruction.
You are reading this letter because a potential applicant has contacted you and desires to complete their
clinical practicums in your laboratory. The program strives to ensure that student clinical experiences are
consistent no matter the location and provide exposure to the broad spectrum of modern laboratory testing.
The program provides clinical objectives and competency checklists in addition to evaluations to assist you
in evaluating the student’s mastery of the expected skills during clinical practicums.
We are requesting your assistance at this time to determine whether the program clinical requirements can
be accomplished at your facility. Please complete the Clinical Facility Fact Sheet (CFFS) provided with
this letter. Once the form has been completed, please give them to the applicant who will return it to the
GW MLS program as part of the application process. Registration will be withheld if the program has not
received a completed Clinical Facility Fact Sheet.
Upon receiving the CFFS, the GW MLS clinical coordinator will contact your facility to further coordinate
the process. We appreciate your thoughtful consideration to support this innovative program for individuals
who wish to begin or advance their career in the medical laboratory. If you have any questions, please do
not hesitate to contact us.
Carol A. Rentas, M.Ed., MT(ASCP)
Assistant Professor and Clinical Coordinator
Medical Laboratory Sciences Program
carentas@gwu.edu
(202) 994-5219
CLINICAL FACILITY FACT SHEET
Institution: ___________________________________________________________________________
Address: __________________________________ City, State, Zip Code: _______________________
Telephone: ( __
)______________________ ____ Fax: ( __ )_____________________________
☐TJC
Accredited by: (check all that apply):
☐CAP
☐COLA
☐CMS
☐ISO
NOTE: If the facility is not accredited by at least one of the above agencies, a list of safety features is
required:
_____________________________________________________________________________________
Clinical Coordinator / Contact at site: Name: ______________________________________________
Email: ______________________________________________
Clinical Laboratory Volume (specify annual number of procedures): _____________________________
Indicate whether tests are performed in the following areas
Hematology: _______
Chemistry: _______
Immunology/Serology: ______ Immunohematology: ______
Microbiology: ________
Urinalysis: _______
Molecular Diagnostics: ______
Total Space of Laboratory: ___________
Daytime laboratory staff
Number Employed
Pathologists
__________ (convert part-time to full-time equivalent)
Credentialed Laboratorians
__________ (convert part-time to full-time equivalent)
Major equipment:
1. __________________________
2. __________________________
3. __________________________