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ASCLS

The American Society for Clinical Laboratory Science

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Membership
Education
Communication
Participate
Advocacy-Issues
Careers
P.A.C.E.
About Us

ASCLS Candidate Information Form

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ASCLS Candidate Information Form

This form is standardized to solicit the information that the ASCLS Nominations Committee needs to process your nomination and, in the event of your selection to candidacy, the information ASCLS Today needs to publicize your candidacy as required by the bylaws. Please fill in the complete information exactly as requested, without substitution or omission. Curriculum vitae will NOT be accepted.

The form must be completed in one session and cannot be saved. Before beginning, please download, complete and save the ASCLS Candidate Professional Involvement Form you will submit later in this process. Save the completed form as a Word document or PDF and include your last name within the file name.

By submitting this form you are agreeing to the terms of the Consent to Serve and confirming that you meet the Qualifications/Eligibility requirements for the position for which you are applying.

Position(Required)

Consent to Serve and Eligibility

I confirm my eligibility and willingness to serve in the office of President-Elect and agree to abide by the campaign regulations.

Term of office: 1 year followed by 1 year as ASCLS President and 1 year as Past President

Eligibility

Members, who have been members for at least five consecutive years prior to election, are eligible for election to the Board of Directors of the Society. An officer of this Society may be nominated for a different office; where upon resignation of the currently held position is affected upon the installation in the new office.

Recommendations

All candidates should attend the Annual Board Meeting and Society Update held at the Annual Meeting either virtually or face-to-face. All candidates are expected to attend the Meet the Candidates event at JAM either virtually or face-to-face, and, if elected, stay for the complete House of Delegates meeting through the installation ceremony either virtually or face-to-face. Candidates elected to the Board of Directors are expected to attend the post House of Delegates meeting of the Board, which is only held in a face-to-face format.

Campaign Regulations

No campaign materials are to be displayed or posted in the hotel or convention facility.
All campaign materials must be distributed at least thirty (30) days prior to the opening of the Annual Meeting with the exception of informational materials that are required for persons nominated from the floor of the House of Delegates at its first session.

I confirm my eligibility and willingness to serve in the office of Secretary-Treasurer and agree to abide by the campaign regulations.

Term of office: 3 Years

Eligibility

Members, who have been members for at least five consecutive years prior to election, are eligible for election to the Board of Directors of the Society. An officer of this Society may be nominated for a different office; where upon resignation of the currently held position is affected upon the installation in the new office.

Recommendations

All candidates should attend the Annual Board Meeting and Society Update held at the Annual Meeting either virtually or face-to-face. All candidates are expected to attend the Meet the Candidates event at JAM either virtually or face-to-face, and, if elected, stay for the complete House of Delegates meeting through the installation ceremony either virtually or face-to-face. Candidates elected to the Board of Directors are expected to attend the post House of Delegates meeting of the Board, which is only held in a face-to-face format.

Campaign Regulations

No campaign materials are to be displayed or posted in the hotel or convention facility.
All campaign materials must be distributed at least thirty (30) days prior to the opening of the Annual Meeting with the exception of informational materials that are required for persons nominated from the floor of the House of Delegates at its first session.

I confirm my eligibility and willingness to serve in the office of Director and agree to abide by the campaign regulations.

Term of office: 3 Years

Eligibility

Members, who have been members for at least five consecutive years immediately prior to election, are eligible for election to the Board of Directors of the Society.
Nominees may run for membership on the Board of Directors of the Society while serving as a constituent society elected official. However, upon election to the Board of Directors of the Society, the individual must resign their elected position in the constituent society.

Recommendations

All candidates should attend the Annual Board Meeting and Society Update held at the Annual Meeting either virtually or face-to-face. All candidates are expected to attend the Meet the Candidates event at JAM either virtually or face-to-face, and, if elected, stay for the complete House of Delegates meeting through the installation ceremony either virtually or face-to-face. Candidates elected to the Board of Directors are expected to attend the post House of Delegates meeting of the Board, which is only held in a face-to-face format.

Campaign Regulations

No campaign materials are to be displayed or posted in the hotel or convention facility.
All campaign materials must be distributed at least thirty (30) days prior to the opening of the Annual Meeting with the exception of informational materials that are required for persons nominated from the floor of the House of Delegates at its first session.

I confirm my eligibility and willingness to serve on the Nominating Committee and agree to abide by the campaign regulations.

Term of office:2 Years

Eligibility

Professional or emeritus members, who are and have been active members in the Society for five (5) years or more prior to election. No officer or director, elected or appointed, of this Society is eligible with the exception of the sitting past-president.

Recommendations

All candidates should attend the Annual Board Meeting and Society Update held at the Annual Meeting either virtually or face-to-face. All candidates are expected to attend the Meet the Candidates event at JAM either virtually or face-to-face, and, if elected, stay for the complete House of Delegates meeting through the installation ceremony either virtually or face-to-face. Candidates elected to the Board of Directors are expected to attend the post House of Delegates meeting of the Board, which is only held in a face-to-face format.

Campaign Regulations

No campaign materials are to be displayed or posted in the hotel or convention facility.
All campaign materials must be distributed at least thirty (30) days prior to the opening of the Annual Meeting with the exception of informational materials that are required for persons nominated from the floor of the House of Delegates at its first session.

I confirm my eligibility and willingness to serve on the Judicial Committee and agree to abide by the campaign regulations.

Term of office: 5 Years

Eligibility

Active professional or emeritus members, who have served previously as an officer, director, or presiding official of the Bylaws Committee of this Society.
Current or previous members of this committee may only serve one term and shall not be eligible for reelection by the Society.

Recommendations

All candidates should attend the Annual Board Meeting and Society Update held at the Annual Meeting either virtually or face-to-face. All candidates are expected to attend the Meet the Candidates event at JAM either virtually or face-to-face, and, if elected, stay for the complete House of Delegates meeting through the installation ceremony either virtually or face-to-face. Candidates elected to the Board of Directors are expected to attend the post House of Delegates meeting of the Board, which is only held in a face-to-face format.

Campaign Regulations

No campaign materials are to be displayed or posted in the hotel or convention facility.
All campaign materials must be distributed at least thirty (30) days prior to the opening of the Annual Meeting with the exception of informational materials that are required for persons nominated from the floor of the House of Delegates at its first session.

Contact Information

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

ASCLS Member Number(Required)

Phone(Required)

Join Year(Required)

What year did you join ASCLS?

Lapsed Years (if any)

Please list any years when your membership lapsed.

Employment

Current Employer

Current Title

Employer Location

City State ZIP Code

Professional Practice Setting

Select all applicable professional practice settings that you currently and actively work. If a professional practice setting is not listed, please provide.

Academic Medical Center

Commercial/Reference Laboratory

Community Hospital (<100 beds)

Compliance/Regulatory

Critical Access

Government/Military/Federal

Higher Education

Hospital (>100 beds)

Indian Health Services

Industry

Physician Office Lab (POL)

Public Health

Other

Professional Practice Setting - Other

Please provide detail on your choice of "Other."

Licensure State

Do you currently practice in a state requiring professional licensure?

Yes

Community

Select the community type in which you work.

Rural

Suburban

Urban

Historically Excluded Groups

Please select any of the historically excluded groups of which you are part.

None

Culture (Culture refers the pattern of daily life learned consciously and unconsciously by a group of people. These patterns can be seen in language, governing practices, arts, customs, holiday celebrations, food, religion, dating rituals, and clothing)

Disability (Disability refers an impairment that may be cognitive, developmental, intellectual, mental, physical, sensory, or some combination of these)

Ethnicity (Ethnicity refers a social construct which divides individuals into smaller social groups based on characteristics such as a shared sense of group membership, values, behavioral patterns, language, political and economic interests, history and ancestral geographical base)

LGBTQIA+ (LGBTQIA+ refers to the diverse groups of lesbians, gay, bisexual, transgender, intersex, and asexual and/or corresponding queer alliances/associations)

Race (Race refers to the identification of people into groups based on various sets of physical characteristics)

Other

Prefer Not to Answer

Other Historically Excluded Groups

Education and Credentials

Certifications(Required)

Please select any certifications you have achieved.

Diplomate in Laboratory Management

HHS Clinical Laboratory Technician

Histotechnologist

Medical Laboratory Scientist MLS(ASCP)

Medical Laboratory Technician MLT(ASCP)

Medical Laboratory Technician AMT

Medical Laboratory Scientist (Technologist) AMT

Medical Technologist MT(ASCP)

MLS Specialist (SBB, SC, SH, SM, SCT, SLS)

MLS/Categorical (BB,C, CG,H, M, MB)

Phlebotomy Technician, PBT

Other

Certifications - Other

Please provide detail on your choice of "Other."

Education(Required)

Please select any degrees you have earned.

High School

Associates

Bachelors

Masters

PhD

EdD

DCLS

Other

Education - Other

Please provide detail on your choice of "Other"

Clinical Focus

Please select all applicable areas of focus in which you have actively worked.

Administration

Blood Bank

Clinical Chemistry

Flow Cytometry

Generalist

Hematology

HLA/Histocompatibility

Immunology/Serology

Informatics

Microbiology

Molecular

Point of Care

Other

Clinical Focus - Other

Please provide detail on your choice of "Other."

Professional Practice Focus

Please select all applicable areas of professional practice in which you have actively worked.

Administrator (Director/Manager/Supervisor) Clinical Practice

Administrator (Director, Dept. Head, Dean) in Higher Education

Bench Practitioner (Any level including phlebotomist, lab assistant etc.)

Consultant

Educator Instructor (university/college based)

Educator/Clinical Coordinator (Hospital Laboratory based)

Traveler

Other

Professional Practice Focus - Other

Please provide detail on your choice of "Other."

Involvement

Professional Involvement Form

Please fill out the ASCLS Candidate Professional Involvement Form. Please rename the file to include your last name before uploading.

Max. file size: 2 MB.

Additional Information

Why are you interested in this role?(Required)

Limit: 1,200 characters

Candidate Picture(Required)

Please upload a candidate picture in the JPG or PNG format of no more than 2 Mb.

Max. file size: 2 MB.

The American Society for Clinical Laboratory Science
P.O. Box 92 | Dundee, MI 48131
Ph. 301.478.6379 | Email ascls@ascls.org

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