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1. First name: (Required.)

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2. Last name: (Required.)

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3. Email address: (Required.)

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4. Phone number: (Required.)

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5. Please provide your NSH Member Number:
Eligible applicants must be a current NSH member.
You can find this by logging into your dashboard (www.nsh.org/my-dashboard) and copying the Customer ID under your profile picture. (Required.)

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6. Describe how earning your certification will help you progress toward your professional goals? (Required.)

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7. Describe how obtaining your histology certification will impact your ability to contribute to the laboratory or patient care. (Required.)

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8. Please upload a headshot:

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9. I certify that I will be sitting for the HT(ASCP), HT(ASCPi), HTL(ASCP) and HTL(ASCPi) exam within 6 months of completing this application. (Required.)

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