Call today! 513-569-1643

Course Training Topics:This course provides training in: Anatomy and physiology of the circulatory

system Medical terminology and laboratory theory Laboratory law, ethics and regulatory issues Pediatric & geriatric blood collection Phlebotomy theory/ simulated lab Arterial, intravenous (IV) & special collections

procedures Specimen collection, processing and handling Blood collection systems, review of medical

asepsis and hand washing Blood and blood composition, blood tubes,

coagulation, venipuncture protocols, workingwith a training arm

Blood banks and blood typing, lab departmentsand personnel

Universal precautions - safety protocols,infection control

Respiratory, pneumonia & TB isolationprotocol, live venipunctures & skin punctures,syringe practice

CBC/DIFF, hematological lab tests, diseaseand disorders, order of drawTraining arm practice and other clinical labexercises

The 90 hour Phlebotomy Technician Program prepares professionals to collect blood specimens from clients for the purpose of laboratory analysis. Students will become familiar with all aspects related to blood collection and develop comprehensive skills to perform venipunctures completely and safely. Classroom work includes terminology, anatomy and physiology; blood collection procedures; specimen hands-on practice; and clinical training in skills and techniques to perform puncture methods. The program also includes lab exercises, live blood draws, work with a training arm and other exercises intended to prepare students to function as an entry level Phlebotomy Technician.

Cincinnati State Workforce Development Center 10100 Reading Road, Cincinnati, Ohio 45241 Phone: 513-569-1643 Email: askwdc@cincinnatistate.edu

www.cincinnatistate.edu/WDC

SPRING CLASS ENROLLING NOW!Register Today!

Starts January 28, 2020 Course Times: 6:00 PM - 10:00 PM

Tuesday & Thursday E Cost: $1,799*

*Fee includes NHA certification exam.

PhlebotomyTechnician

Week  Tuesday  Hours  Thursday  Hours 

1  January 28, 2020  6:00 PM ‐ 10:00 PM  January 30, 2020  6:00 PM ‐ 10:00 PM 

2  February 4, 2020  6:00 PM ‐ 10:00 PM  February 6, 2020  6:00 PM ‐ 10:00 PM 

3  February 11, 2020  6:00 PM ‐ 10:00 PM  February 13, 2020  6:00 PM ‐ 10:00 PM 

4  February 18, 2020  6:00 PM ‐ 10:00 PM  February 20, 2020  6:00 PM ‐ 10:00 PM 

5  February 25, 2020  6:00 PM ‐ 10:00 PM  February 27, 2020  6:00 PM ‐ 10:00 PM 

6  March 3, 2020  6:00 PM ‐ 10:00 PM  March 5, 2020  6:00 PM ‐ 10:00 PM 

7  March 10, 2020  6:00 PM ‐ 10:00 PM  March 12, 2020  6:00 PM ‐ 10:00 PM 

8  March 17, 2020  6:00 PM ‐ 10:00 PM  March 19, 2020  6:00 PM ‐ 10:00 PM 

9  March 24, 2020  6:00 PM ‐ 10:00 PM  March 26, 2020  6:00 PM ‐ 10:00 PM 

10  March 31, 2020  6:00 PM ‐ 10:00 PM  April 2, 2020  6:00 PM ‐ 10:00 PM 

11  April 7, 2020  6:00 PM ‐ 10:00 PM  April 9, 2020  6:00 PM ‐ 10:00 PM 

12  April 14, 2020  6:00 PM ‐ 10:00 PM 

Cincinnati State Workforce Development Center Spring Session Phlebotomy  Technician Program – CSTCC 

Tuition: $1,799 ‐ Total Hours 90 

Workforce Development Center Application/Registration Form Please print legibly & use black or blue ink

__________________________________________________________________________________________________________________________________________ Last Name First Name Middle Name

__________________________________________________________________________________________________________________________________________ Home Address Apt. #

__________________________________________________________________________________________________________________________________________ City State Zip Code County (i.e. Hamilton)

___ ___ ___ - ____ ____ ____ - ____ ____ ____ ____ ___ ___ ___ - ____ ____ ____ - ____ ____ ____ ____ ____ ____ ____ - ____ ____ - ____ ____ ____ ____ Area Code Home Phone Number Area Code Business Phone Number Social Security Number

How did you hear about this training? ____________________________________________________________________________________________________________

Are you a resident of Ohio? ? Yes ? No If yes, how long? ____ ____ Years ____ ____ Months E-mail address: ____________________________________________

If you do not live in Ohio, which state do you live in? ________________________ County __________________________ How long? ____ ____ Years ____ ____ Months

Are you a US citizen? ? Yes ? No If you are not a US Citizen, please complete the following: Country of citizenship: ______________________________________________

Type of Visa: ________________________________ Immigration/VISA status: ______________________________ Are you applying for resident alien status? ? Yes ? No

Are you a resident alien? ? No ? Yes, Card# ______________________ Have you been issued an Employment Authorization Card? ? No ? Yes, Card # ______________________

If you have special circumstances (political asylum or refugee status) differing from a “Permanent Resident Card” or Visa, please explain: _____________________________

__________________________________________________________________________________________________________________________________________

Date of Birth: (mm) ____ ____ (dd) ____ ____ (yy) ____ ____ Marital Status: ? Married ? Single ? Divorced ? Widow(er) Add you to our mailing list? ? Yes ? No

Selective Service Number (ages 18 – 26) _______________________________________________________ You can register and/or obtain your number by going to www.sss.gov

Your Social Security number is required and is used only for the Ohio Board of Regents and Internal Revenue Service Reporting. Your Selective Service number is required and is used only in collecting government subsidy for the College.

Have you ever attended Cincinnati State Technical and Community College before? ? Yes ? No If yes, when? __________________________________________________

If you are a new student (first time filling out this form), please complete the information in the box below.

Department Dept. Code

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• The student acknowledges, by submitting this form to conduct registration activity to the College, responsibility for the timely payment of tuition and all other charges incurred while at the college. • By submitting this form to conduct registration activity, the student also agrees that if the student becomes delinquent in the payment of such chargesand tuition, the student will also pay the costs of collection (up to 50% of the delinquent account) when assigned to a collection agency. • The student acknowledges that an outstanding balance owed to the College and/or academic probation, suspension or dismissal will suspend registration.

Student Signature _______________________________________________________________________________________ Date _______________________________ Registration will not be processed without your signature

Payment Information – Please complete if your company or some other agency will be paying your tuition, otherwise you are responsible for all tuition and/or related course fees.

To Pay by Credit Card: Please call our Client Management Specialists at 513-569-1643 with your credit card information

Company: ___________________________________________________________________________ Phone #: ___ ___ ___- ___ ___ ___ - ___ ___ ___ ___

P/O # or Check #: ____________________________

Company Address City, State, Zip Code _______________________________________________________________________________________________________________________________________________

Contact Person: ___________________________________________________ Signature: _______________________________________________

Complete this form and mail to: Cincinnati State Technical and Community CollegeWorkforce Development Center, 10100 Reading Road, Cincinnati, OH 45241 Phone: (513) 569-1643 Fax: (513) 569-1801

The information in this box is required in order that we may demonstrate this institution’s compliance with Title VI of the 1964 Civil Rights Act. This information is protected under the Federal Privacy Act. If you choose not to respond please initial here. ___________________. Gender: Female Male Race: African American/Black American Indian/Alaskan Native Hispanic Caucasian/White Asian or Pacific Islander Other Educational Goal: Professional Development Career Exploration Personal Enrichment Associate Degree Certificate Associate Degree for transfer Knowledge for personal interest Training for a new career by taking only selected courses

NA NC NA Phlebotomy - Spring 0.00 01/28/20 04/14/20

File# 20.7800 Company Open Enrollment

Term 20/SP