The Academy of Medical Laboratory Science
Application Form M2
Office only
Membership No:
Details:
Title
Surname
Forename
Dr / Mr / Mrs / Ms
Address
Date of Birth
Contact Tel:
Email:
Passport No:
Country of Issue
3rd Level Qualifications:
For each qualification listed please provide:
1) A certified English translation of the Diploma/Degree and a copy of the original Diploma/Degree attained. (Not original documents)
2) A certified statement from the relevant educational institute detailing, in English, the syllabus of the course undertaken and the ECT credits for each module.
3) A certified statement from the relevant educational institute detailing, in English, the examination results obtained from each examination session.
4) Statement of equivalence of qualification to Degree Level, for Non EU applicants a QQI statement is required (Quality & Qualifications Ireland Email: info@qqi.ie )
BSc / Diploma
Course Title
College
City
Country
Graduation Year
EQF / QQI Level
Circle as required
Post Graduate Education
MSc
Certified Clinical Placement:
Hospital / Clinical laboratory
Subject
Start Date
Finish Date
Cellular Pathology
Clinical Biochemistry
Haematology
Medical Microbiology
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