Apply Application Course 2 2024-11-11 Please Note! If you already applied and paid to take the full 3 course program, you do not need to submit this application again. You should submit this application if:You wish to apply and pay for the full 3 course program and did not do so previously.ORYou wish to apply and pay for Course 2 of the program at the single course rate. Please see the FAQ on the program webpage for more information. This application form closes January 7, 2025. Personal Information Important! Do NOT submit this form on behalf of another person. The information below is what will be associated with your course enrollment, and all communication will be via the email account you specify below. First Name / Given Name * Middle Name Last Name / Family Name * Email * Use your own email address. This email will be associated with your enrollment and cannot be used by another person. Confirm Email * Telephone number We encourage you to submit a phone number in full international format that includes a plus sign (+) followed by the country code, city code, and local phone number. For example, if you are in the United States (country code "1") and have the area code "206" and phone number "XXX-XXXX", you'd enter +1 206 XXX XXXX For country code reference, see: IBAN International country calling codes Gender — select —ManWomanTransgender ManTransgender WomanNon-binary/Genderqueer/AgenderMy gender is not listedPrefer not to answer Organization Country of Residence * — select —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas (the)BahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean Territory (the)Brunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman Islands (the)Central African Republic (the)ChadChileChinaChristmas IslandCocos (Keeling) Islands (the)ColombiaComoros (the)Congo (the Democratic Republic of the)Congo (the)Cook Islands (the)Costa RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican Republic (the)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (the) [Malvinas]Faroe Islands (the)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Territories (the)GabonGambia (the)GeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (the)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (the Democratic People's Republic of)Korea (the Republic of)KuwaitKyrgyzstanLao People's Democratic Republic (the)LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall Islands (the)MartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (the Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands (Kingdom of the)New CaledoniaNew ZealandNicaraguaNiger (the)NigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana Islands (the)NorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippines (the)PitcairnPolandPortugalPuerto RicoQatarRomaniaRussian Federation (the)RwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudan (the)SurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab Republic (the)Taiwan (Province of China)TajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos Islands (the)TuvaluTürkiyeUgandaUkraineUnited Arab Emirates (the)United Kingdom of Great Britain and Northern Ireland (the)United States Minor Outlying Islands (the)United States of America (the)UruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern Sahara*YemenZambiaZimbabweÅland Islands Note: The LMIC rate (Low or Middle Income Country) is based on country of residence. More information The OECD rate (Organization for Economic Cooperation and Development) is based on country of residence. More information Primary Language — select —AmharicArabicBengaliEnglishFrenchGermanHausaHindiIgboJapaneseJavaneseKoreanMalay/IndonesianMandarinMarathiOromoPortuguesePunjabiRussianShonaSpanishSwahiliTamilTeluguVietnameseYorubaWuZuluOther: Primary Language LMIC discount Qualifies for LMIC discount This is a read-only field. It automatically updates based on the "Country of Residence" selection. Enrollment Selection Enrollment Instructions With this application, you can either register for a single course (Course 2: Operational Quality Management in the Clinical Laboratory) at the single course rate, or you can register for the full program (which includes 3 courses). If applying for the full program (3 courses) at this time, you are eligible for a discount. Note: This program discount is only available if all 3 courses are purchased at the time of application. Please note that for the full program, the order of the courses you will be enrolled in is listed below. If you previously enrolled in Course 1 or Course 3 at the single course rate and would now like to take Course 2, please select the "single course" option below. Please see this FAQ on the program webpage for answers to commonly asked application-related questions. Upcoming application periods for Course 3, and later for Course 1 as single course enrollment options are posted on the program website. Courses by Date Offered: Course 2: Operational Quality Management in the Clinical Laboratory (January 21 – March 30, 2025) Course 3: Quality Control Methods in the Clinical Laboratory (April 7 – June 15, 2025) Course 1: Leadership and Management in the Clinical Laboratory (September 29 – December 7, 2025) Cost: Single course: $200 USD (LMIC rate) / $500 USD (OECD rate) All three courses (entire certificate program): $500 USD (LMIC rate) / $1200 USD (OECD rate) Please make your selection below for which course(s) you would like to enroll. * All three courses (entire certificate program) Single course: Operational Quality Management in the Clinical Laboratory Once you submit this application, you will be prompted to send payment via credit card for the course fees. At this time, credit cards are the only accepted form of payment for the course. Other payment types may be available in the future. Qualifications and Employment Education * — select —Less than SecondarySecondary (e.g., Secondary school [stage two/upper grades], senior secondary school or [senior] high school.)Post-Secondary (e.g., Certificates and diplomas obtained through colleges, vocational schools or technical schools, technician diploma, primary professional education or préparation aux carrières administratives)Short-Cycle Tertiary: (e.g., Higher technical education, technician or advanced/higher vocational training, associate degree, or bac+2)Bachelors or equivalent (e.g., BS, BA, BSN or in Medical Laboratory Science)Masters or equivalent (e.g., MD, MPH, MS, MSW)Doctoral or equivalent (e.g., PhD, DRPH) Please indicate the highest level of education you have attained. Professional Certifications American Society for Clinical Pathology (ASCP) Certified Laboratory Medical Scientist IMLS (International Medical Laboratory Scientist or ASCPi Certified) Licensed/Registered/Certified Medical Doctor or Physician Licensed/Registered/Certified Nurse Licensed/Registered/Certified Midwife Licensed/Registered/Certified Community Health Worker Licensed/Registered/Certified Pharmacist Licensed/Registered/Certified Dentist OtherOther What best represents your current primary work role/job title? * — select —Research Laboratory staffClinical Laboratory StaffClinical OfficerCommunity Health WorkerPhysicianMedical StudentResidentFellowNurseMidwifeDentistCounselor/therapistPharmacistProgram/administrative staffGovernment health officialProfessor/lecturerResearcherOther What best represents your current primary work role/job title? What best represents your employer type/work setting? * — select —Research laboratoryClinical laboratoryClinical care/hospital/clinicUniversity/college/other schoolNon-governmental organizationFaith-based organizationCommunity-based organizationGovernment organizationPharmacyCorrectionsMilitaryOther What best represents your employer type/work setting? Previous Courses Completed Have you taken any online courses with our partner eDGH before? * Yes No Please select all that you have completed (received a certificate). Leadership and Management in Health Project Management in Global Health Introduction to Epidemiology in Global Health Economic Evaluation in Global Health Clinical Management of HIV Fundamentals of Implementation Science Fundamentals of Global Health Research (previously Conducting Research Responsibly) Monitoring & Evaluation in Global Health Global Mental Health Policy and Advocacy in Global Health Wellbeing for Health Professionals Communication eDGH is a provider of high quality online learning for health professionals. It is collaborating with the Department of Laboratory Medicine and Pathology to offer this program. I would like to be added to the eDGH mailing list to receive information about additional online courses that eDGH offers. Add me to the eDGH mailing list Yes Policy Course Participation: Please plan to spend 6-9 hours per week reviewing course materials and completing assignments. Refunds: Full refunds will be issued for a course if we are notified up to one working day prior to the start of the course. If you paid for the complete course program at the discounted rate and are unable to proceed with one of the courses in the program, you may contact us about the possibility of a credit for that course so you can complete the program at a later date. Please contact us prior to the start of the course. Certificates: Upon successful completion of the course, we will issue you a certificate of completion based on the name provided in the personal information section. Changes to certificates after the course ends will be subject to a $10 replacement fee. More information about certificates. Certificate Program Communications: After applying for a course, we may communicate with you about upcoming courses in Laboratory Medicine and application dates. If you do not wish to receive these communications, you are welcome to opt-out or you can contact dlmp-cert@uw.edu to request this. Privacy and Data Use Policy: By providing this information, you are granting the University of Washington’s Department of Laboratory Medicine & Pathology and Department of Global Health permission to store and access your personal data for communication related to your application and enrollment in our courses. For more information about how your data is used, please see our Privacy and Data Use Policy. Course Policy Acceptance * I accept the course policy above as the terms of my participation in this online course. Confirmation You will receive an auto-confirmation email that your application has been received. Please check your spam or junk mail folder if you do not receive it. This email will link to the payment page to submit payment for the course that you have selected. Payment is required in order for your application to be complete and is due immediately, or by 7 January 2025 (when applications close) at the very latest. Please do not remit your payment after the application close date. Confirm * I understand Captcha Submit If you are human, leave this field blank.