* Required

Phlebotomy Technician Certification Program Application

Lompoc Adult School and Career Center

Complete this application if you would like to be considered for admission to one of our upcoming programs.

You will be contacted as soon as your application is reviewed.

All applicants will receive an invitation to a Zoom meeting with the program director to discuss the program and to answer any questions.

First Name*required

Middle Name

Last Name*required

Street Address*required

City*required

Phone Number*required

Email Address*required

Birth Date*required (mm/dd/yyyy)

Please explain your clinical work experience:*required

What times of day are best for a Zoom meeting?*required

What is the best way to contact you?*required