Phlebotomy Application

Prior to filling out this application, please refer back to the program packet, also online. There are required documents that must be provided to the Nursing and Allied Health programs before you can be considered for admission.

Attention applicants: You will need to provide a copy of your official transcripts from high school or GED, college, university or trade school for each program you are applying to; even if you applied to our programs in the past.

Please note: the Nursing and Allied Health Department will no longer be pulling old transcripts from previous files/programs.

We appreciate your continued interest in our programs, however, due to our limited resources, we ask that you provide new transcripts when you apply to other programs. Transcripts are required for admission.

Application for Admission to the PDCCC Phlebotomy Program


PDCCC History: Please answer yes or no


Education History

  • (explain)

Employment History

  • (Name, Address, Supervisor’s Telephone #)
  • (Name, Address, Supervisor’s Telephone #)

Career Goals

  • I certify that this information is accurate and complete. I understand that giving incomplete or false information is grounds for denial of the application. I authorize Paul D. Camp Community College to request such information as necessary to verify my qualifications/suitability for the Nursing Program for which I have applied. I hereby release from all liability or damage those individuals who provide information related to my education or character and waive any rights of inspection of such information.

    Nursing students are involved in the provision of direct patient care in medical facilities. Certain medical facilities require all nursing students to have a Virginia State Police criminal history and sex offender’s crimes against minors background investigation completed prior to the provision of patient care. Some facilities may also require drug testing for nursing students. Any student found guilty of a misdemeanor or felony prior to or during nursing education will be required to request an Exemption from Disqualification from each of the medical facilities to which they may be assigned during the program. If an exemption is not granted by the medical facility, the student will be unable to complete the requirements for the nursing program, and will not be permitted to progress through the program. Students will be required to submit similar documentation to the Virginia Board of Nursing when making application to take the registered nursing exam in Virginia. The Board of Nursing can deny licensure to any applicant who has filed false credentials, who has falsely represented facts on the application for licensure, and/ or who has committed a felony or misdemeanor. In addition, certain health care facilities may not hire individuals who have committed a felony or misdemeanor.

    I understand that the responsibility for providing all transcripts and documentations to the nursing office lies with the applying student. Failure to provide required documents will be grounds for non-acceptance. I understand that the following documents are required:

    1. Official transcripts from high school or GED scores, colleges, and other higher education facilities

    2. Evidence of U.S. citizenship or authorization to reside in the United States

Verification