*1.First name:(Required.)

*2.Last name:(Required.)

*3.Email address:(Required.)

*4.Phone number:(Required.)

*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.)

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

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

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.)

I agree.

I disagree.