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Phlebotomy Application

NOTE: Fields marked with * are required.

Student Information
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This is a private class provided for students of the Region Five Educational Service Center and is not open for public registration.
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Email is the preferred method of communication. Please provide an email address that you check regularly. If you do not have an email address, please make sure you provide good contact phone numbers.
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Demographic Information
Are you Hispanic or Latino:*
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Racial Group (select all that apply):*





Gender:*
Are you a US Citizen:*
PLEASE READ CAREFULLY

If you have any questions or concerns prior to submitting your application, please contact the Dean of Technical Programs/Workforce Training Office at (409) 984-6238.

Space is limited so registration for the course will be a first come, first serve basis.

Applicants Eligibility and General Requirements

Applicants must:

  • Complete and submit this application form
  • Tuition and Fees must be paid in full and all admission requirements satisfied by published deadlines.
  • Submit completed documentation of ALL requirements prior to being able to register for the class.

Please note some of these requirements have time-sensitive deadlines.

Acceptance of an application does not guarantee a student a seat in the course. Classes may fill quickly, preventing you from registering even though you have completed the application process. Students must notify the Workforce/Continuing Education and the Admission and Records offices of any change in applicant data. Failure to do so may result in the withdrawal of permission to register in the classes or the inactivation of the application. The tuition payment must be paid in full and all admission requirements satisfied by published deadlines or students will be dropped from the program.

Access to Lamar State College-Port Arthur's programs or activities shall not be limited on the basis of race, color, creed, national origin, religion, age, gender, sexual orientation, political affiliation, or physical disability. Applications accepted year round.

Completed forms may be submitted in person to the "Dean of Technical Programs/Workforce Training Office" located on the first floor of the Madison Monroe Education building, Room 121, at 1500 Procter Street, or by mail to:

Dean of Technical Programs/Workforce Training Office
Lamar State College - Port Arthur
P. O. Box 310
Port Arthur, TX 77641

Acknowledge and Submit Application
Acknowledgment:*
  • I hereby certify that the information contained in this application is true and complete to the best of my knowledge.
  • I understand that any misrepresentation or falsification of information is cause for denial of admission or expulsion from the College.
  • I understand that the faculty and staff of the Continuing Education and Admission and Records offices will read the information contained in this application.
  • I have read and understood all information included on this application and all related documents and requirements.