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Voting Cytotechnologist Membership Application

For a Voting Cytotechnologist Membership Application to be considered complete, it must be completely filled out and accompanied by the required uploaded document.

To apply for Voting Cytotechnologist status you must be a Cytotechnologist Member in good standing for at least three (3) years and have met five (5) of the professional requirements listed in the application below.

Applicant Information
*	Gender:
*	ASC Member Number:
*	First Name:
	Middle Initial:
*	Last Name:
*	Credentials:
	Title:
*	Email Address:
*	Preferred Mailing Address:
Institution Contact Information
	Institution Name:
	Department:
	Institution Mailing Address:
	Phone Number:
	Fax Number:
Home Contact Information
	Home Address:
	Phone Number:
	Fax:
Applicant's Education
*	Accredited Program:
*	Certification:
*	Dates of Attendance:
Document Requirements Please merge all required documents into one (1) file for uploading purposes. - A Curriculum Vitae (CV) may be submitted as documentation for some requirements - A copy of advanced degrees and/or certification - Documentation of at least five (5) professional requirements listed below.
*	Upload merged document here:
Professional Requirements To apply for Voting Cytotechnologist status you must be a Cytotechnologist Member in good standing for at least three (3) years, and have met five (5) of the professional requirements listed below.
*	Please select at least five (5) requirements you have fulfilled:	Engagement in the practice of Cytotechnology for five (5) years. Teaching of Cytotechnology for a period of three (3) years Authorship or co-authorship of two (2) papers published in professional journals Faculty rank at a university Occupying the position of Chief or Supervisory Cytotechnologist or Education Coordinator Membership on committees, workshop programs or scientific programs of the ASC Holding a degree above the baccalaureate level Holding or having held an office and/or position as a workshop director in a state and/or regional society Attendance at three (3) meetings of the American Society of Cytopathology Authorship or co-authorship of two (2) poster or platform presentations at the ASC Annual Scientific Meeting or other meetings appropriate to cytology, laboratory management or scientific investigations. Examples: ASCP/CAP, USCAP, CLMA Additional cytology certification Documented committee membership and/or in-service educational instruction within own institution Documentation of participation in local/state/regional outreach programs

	Additional Training or Experience in Cytopathology:
The ASC Membership Committee will review your completed application. You will be notified once your application has been approved by the Committee.