SURGICAL TECHNOLOGY. Certificate of Completion in Surgical Technology Associate of Applied Science Degree in Surgical Technology

Transcription

1 SURGICAL TECHNOLOGY Certificate f Cmpletin in Surgical Technlgy Assciate f Applied Science Degree in Surgical Technlgy INFORMATION & APPLICATION PACKET

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3 108 N. 40th Street Phenix, AZ (602) Dear Prspective Student: We are glad that yu have taken the first step twards chsing yur future career in the exciting field f surgical technlgy. GateWay Cmmunity Cllege s Surgical Technlgy Prgram has: A Natinal Accreditatin CAAHEP and NBSTSA Merit recgnitin fr student pass rates n natinal certificatin exams Credits that transfer t NAU fr a Bachelr s Degree. Surgical Technlgists are highly skilled members f a surgical team that includes surgens, anesthesilgists, and registered nurses. Surgical Technlgists priritize alng with members f this team t prvide safe care t the surgical patients. Surgical Technlgists maintain sterility in the perating rm suite by setting up the perating rm suite with the registered nurse by preparing sterile medical instruments and sterile supplies fr surgery. During a surgical prcedure, the surgical technlgist anticipates surgens needs by passing instruments, retracting tissue, perating specialized equipment, and handling sterile medicatins t the surgen under the surgen s directin. Learn mre and begin by transferring yur transcripts t the Admissins and Recrds ffice and by cntacting a Health Science Academic Advisr at Prgram utcmes are available n the GateWay Cmmunity Cllege website under surgical technlgy. The Accreditatin Review Cuncil n Educatin in Surgical Technlgy and Surgical Assisting reprted data annually is as fllws: GateWay Cmmunity Cllege / Surgical Technlgy Prgram ARC/STSA Annual Reprt 2017 / Prgram Outcmes The prgram will admit 20 students each academic year beginning Fall f The prgram retentin threshld is 60%. The prgram retentin fr was 88%. The prgram participatin rate fr the CST Exam is 100%. The prgram participatin rate fr was 100%. The CST Exam threshld fr pass rate is 70%. The CST pass rate was 86% The graduate placement threshld fr was 80%. The graduate placement was 100%. The emplyer satisfactin return threshld fr was 50%. The satisfactin return rate was 80%. The emplyer satisfactin threshld was 85%. The emplyer satisfactin fr was 88%. Graduates receive a certificate f cmpletin and AAS degree frm GateWay Cmmunity Cllege and als a Certificatin in Surgical Technlgy (CST) frm The Natinal Bard f Surgical Technlgy and Surgical Assisting. Sincerely, Susan Tme Susan Tmé R.N., MS Directr, Surgical Technlgy Prgram STORN, SGT, HCS tme@gatewaycc.edu A Maricpa Cmmunity Cllege learn mre. live better.

4 TABLE OF CONTENTS Career Descriptin... 5 Certificate & Assciate f Applied Science Degree Requirements Surgical Technlgy... 6 Admissin Criteria... 6 Prerequisites fr Certificate Prgram and Assciate f Applied Science Degree... 6 Placement Testing... 6 Prgram Prerequisites... 6 Certificate f Cmpletin / Assciate f Applied Science Degree Surgical Technlgy Prgram Optin I... 7 Certificate f Cmpletin / Assciate f Applied Science Degree Surgical Technlgy Prgram Optin II Surgical Rtatin Case Requirements Estimated Prgram Csts Immunizatins, Testing, and Backgrund Requirements HCS Advanced Placement fr the Surgical Technlgy Prgram Required Text Bks Frequently Asked Questins Accreditatin Plicies, Rules, Requirements, and Regulatins Cmpliance Cllege Cmmunicatin Cntact Infrmatin Hw t Apply & Enrll Student Services Instructins fr DPS Fingerprint Clearance Card Applicatin Instructins fr American Heart Assciatin Healthcare Prvider CPR Card Training Admissin Applicatin fr Surgical Technlgy Prgram Waiver f Licensure / Certificatin Disclaimer Allied Health Student Health and Safety Dcumentatin Checklist Surgical Technlgy Admissin Applicatin Checklist Adviser Review MCCCD Summary f Criminal Backgrund Check Requirements MCCCD Acknwledgement f Criminal Backgrund Check Requirements Surgical Technlgy 4 December

5 CAREER DESCRIPTION Surgical technlgy is an area f healthcare invlving the use f sterile surgical instruments t perfrm surgical prcedures. Surgical Technlgists are an integral part f the surgical team, in the perating rm. Cmmunicating with members f the healthcare team is a key cmpnent. Surgical Technlgists must handle the demands f wrking in an perating rm envirnment, using strng hand-eye crdinatin skills at all times. Jb respnsibilities include: Maintain a prper sterile field during surgical prcedures. Cunt spnges, needles, and instruments befre and after peratin. Hand instruments and supplies t surgens and surgens' assistants, hld retractrs and cut sutures, and perfrm ther tasks as directed by surgen during peratin. Prepare patients fr surgery, including psitining patients n the perating table and cvering them with sterile surgical drapes t prevent expsure. Scrub arms and hands and assist the surgical team t scrub and put n glves, masks, and surgical clthing. Wash and sterilize equipment, using decntaminates, bactericidal agents and sterilizers. Mnitr and cntinually assess perating rm cnditins, including patient and surgical team needs. Prepare dressings r bandages and apply r assist with their applicatin fllwing surgery. Clean and restck perating rm, gathering and placing equipment and supplies and arranging instruments accrding t instructins, such as a preference card. Operate, assemble, adjust, r mnitr sterilizers, lights, suctin machines, r diagnstic equipment t ensure prper peratin. Operate cmputers, rbts, and electrical equipment. Requirements fr physical and mental endurance include: Able t stand, bend, stp, and/r sit fr lng perids f time in ne lcatin with minimum/n breaks. Manipulate instruments, supplies and equipment with speed, dexterity, and gd eyehand crdinatin. Demnstrate the use f psitive cping skills under stress. Demnstrate calm and effective respnses, especially in emergency situatins. Exhibit cmpassinate interpersnal skills during patient, staff, and faculty interactins. Have physical ability t lift a minimum f 20 punds and carry it fr 40 feet. Be able t endure strng cnstructive criticism with a psitive attitude Manage time effectively in lab, in clinical, in class and while studying Be willing t deal with difficult persnalities Be n time fr all cmmitments and always punctual Be able t take directins and fllw rders Be unimpaired by alchl, drugs r any ther factr that culd affect yur judgement and skills negatively. Be cmpliant with randm drug screens. Maintain an academic calendar, adhere t it and share it with yur family members and friends. Mst Surgical Technlgists find emplyment in hspital perating rms, labr & delivery rms, and thers find emplyment in clinics, surgical centers, bne banks, veterinary ffices, endscpy, and phthalmlgy centers and laser spine surgery centers. With additinal training, yu can expand yur rle and advance t Certified Surgical Technlgist First Assistant. First Assistants functin under the directin f the surgen, and will help with patient psitining, visibility fr suturing, retracting, tissue handling, clsing wunds and patient transfers. Surgical Technlgy 5 December

6 CERTIFICATE & ASSOCIATE OF APPLIED SCIENCE DEGREE REQUIREMENTS SURGICAL TECHNOLOGY ADMISSION CRITERIA Students must meet the fllwing criteria t be admitted t the prgram: 1. Frmal applicatin and admissin t the prgram. 2. Backgrund Check Requirements: Admissin t an Allied Health prgram requires that students be in cmpliance with the Maricpa Cunty Cmmunity Cllege District Backgrund Check standards. Upn cnditinal prgram enrllment, the student must cmply with all requirements f the MCCCD backgrund check plicy. 3. Clinical Health and Safety requirements must be met. Upn cnditinal prgram enrllment, the student must cmply with all requirements f the MCCCD clinical health and safety plicy 4. Inability t cmply with Backgrund Check requirements and/r Clinical Health and Safety requirements at the start f classes may result in cancellatin f enrllment. 5. Yu will need a level ne finger print card and current CPR card frm the American Heart Assciatin. Please review the AHA infrmatin in this packet. PREREQUISITES FOR CERTIFICATE PROGRAM AND ASSOCIATE OF APPLIED SCIENCE DEGREE PLACEMENT TESTING Placement testing is designed t identify yur skill levels in English language usage, reading and mathematics. Placement tests are scheduled at a variety f times in GateWay s Testing Center and are free f charge. Please cntact GateWay s Testing Center r visit the website t get updated requirements and hurs f peratin. PROGRAM PREREQUISITES Successful Cmpletin f the fllwing cllege curses with a minimum, cumulative GPA f 2.0. Credits: BIO160 Intrductin t Human Anatmy and Physilgy Lecture/Lab (4) OR + BIO201 Human Anatmy and Physilgy I (4) AND + BIO202 Human Anatmy and Physilgy II (4) 4 8 Students selecting BIO201 and BIO202 OR BIO205 must cmplete the prerequisite curses BIO156 r BIO BIO156 Intrductry Bilgy fr Allied Health (4) OR + BIO181 General Bilgy (Majrs) I (4) OR One year high schl bilgy with a grade f C r better (0) 0 4 BIO162 Micrbilgy Cncepts fr Allied Health (2) OR + BIO205 Micrbilgy (4) MAT090 MAT091 MAT092 MAT093 Intrductry Algebra (5) OR Intrductry Algebra (4) OR Intrductry Algebra (3) OR Intrductry Algebra/Math Anxiety Reductin (5) OR Satisfactry scre n District Placement exam OR Satisfactry cmpletin f a higher level mathematics curse PHY101 Intrductin t Physics 4 Surgical Technlgy 6 December

7 CERTIFICATE OF COMPLETION / ASSOCIATE OF APPLIED SCIENCE DEGREE SURGICAL TECHNOLOGY PROGRAM OPTION I Students must select ne f the fllwing tw (2) ptins which are brken ut by semesters: Credits: Optin I is fr students wh d NOT have a Certified Registered Central Service Technician (CRCST) certificatin thrugh the Internatinal Assciatin f Healthcare Central Service Material Management (IAHCSMM) HCC130 r HCC130AA-AF and HCC145 r HCC146 may be waived by GateWay Health Cre Curriculum Crdinatr ( ) based n relevant industry experience r equivalent r curse educatin. Semester 1 Fall (Prgram Prerequisites) Certificate & AAS Credits: 6-12 BIO160 Intrductin t Human Anatmy and Physilgy Lecture/Lab (4) OR + BIO201 Human Anatmy and Physilgy I (4) 4 Students selecting BIO201 and BIO202 OR BIO205 must cmplete the prerequisite curses BIO156 r BIO BIO156 Intrductry Bilgy fr Allied Health (4) OR + BIO181 General Bilgy (Majrs) I (4) OR BIO162 One year high schl bilgy with a grade f C r better (0) 0 4 Micrbilgy Cncepts fr Allied Health (2) OR + BIO205 Micrbilgy (4) 2 4 Semester 2 Spring (Prgram Prerequisites) Certificate & AAS Credits: BIO202 Human Anatmy and Physilgy II (4) PHY101 Intrductin t Physics MAT090 MAT091 MAT092 MAT093 Intrductry Algebra (5) OR Intrductry Algebra (4) OR Intrductry Algebra (3) OR Intrductry Algebra/Math Anxiety Reductin (5) OR Satisfactry scre n District Placement exam OR Satisfactry cmpletin f a higher level mathematics curse 0 5 Semester 3 Fall Credits: HCC/RES109 CPR fr Health Care Prvider (0.5) OR Prf f current American Heart Assciatin Health Care Prvider CPR card (0) HCC130 HCC130AA HCC130AB HCC130AC HCC130AD HCC130AE HCC130AF Fundamentals in Health Care Delivery (3) OR Health Care Tday (0.5) and Wrkplace Behavirs in Health Care (0.5) and Persnal Wellness and Safety (0.5) and Cmmunicatin and Teamwrk in Health Care Organizatins (0.5) and Legal Issues in Health Care (0.5) and Decisin Making in the Health Care Setting (0.5) ) OR Permissin f GateWay Health Cre Curriculum Crdinatr 0 3 Surgical Technlgy 7 December

8 Semester 3 (cntinued) HCC145 HCC146 Medical Terminlgy fr Health Care Wrkers (3) OR Cmmn Medical Terminlgy fr Health Care Wrkers (2) OR Permissin f GateWay Health Cre Curriculum Crdinatr (0) HCS100/SGT100 Fundamentals f Surgical Services 5 + HCS101/SGT101 Medical Terminlgy fr Surgical Services 1 + HCS102/SGT102 Basic Surgical Instrumentatin fr Surgical Services 2 + SGT135 Instrument Handling I 1 + RDG100AB Successful Cllege Reading - Ntetaking and Studying fr Success (1) OR Curse may be waived by prgram directr if student has cmpleted a bachelr s degree r higher (0) 0 1 Semester 4 Spring Credits: HCS152/SGT152 Advanced Surgical Instruments fr Surgical Services 2 + SGT155 Instrument Handling II 1 + SGT156 Hspital Central Service Practicum fr Surgical Technlgy 1 + SGT165 Surgical Prcedures I 4 + SGT180 Pharmaclgy fr Surgical Technlgy I 1 (The fllwing curses are nly required fr AAS Degree) + ENG101 First-Year Cmpsitin (3) OR + ENG107 First-Year Cmpsitin fr ESL (3) 3 + COM Any apprved general educatin curse frm the Oral Cmmunicatin area; except COM225 Public Speaking 3 Semester 5 Summer (Optinal) Credits: HCS154 Hspital Central Service Practicum 0 7 This semester is ptinal fr SGT students. Only thse seeking t cmplete the Certificate f Cmpletin in Hspital Central Services (5311) and t be eligible t sit fr the Certified Registered Central Service Technician (CRCST) certificate exam frm the Internatinal Assciatin f Healthcare Central Service Material Management (IAHCSMM) shuld take HCS154. This curse is nly ffered in the Summer fr SGT students. In rder fr students t cmplete the required curse wrk fr the AAS degree within tw years, it is recmmended that students take ne General Educatin curse during the Summer. Recmmended General Educatin Curse t take in Summer: + CRE101 Cllege Critical Reading (3) OR + CRE111 Critical Reading fr Business and Industry (3) OR Equivalent as indicated by assessment 0 3 Surgical Technlgy 8 December

9 Semester 6 Fall Credits: SGT200 Operating Rm Practicum l 1 + SGT205 Operating Rm Practicum II 2 + SGT210 Surgical Prcedures II 4 + SGT215 Pharmaclgy fr Surgical Technlgy II 1 (The fllwing curses are nly required fr AAS Degree) + MAT120 Intermediate Algebra (5) OR + MAT121 Intermediate Algebra (4) OR + MAT122 Intermediate Algebra (3) OR Equivalent curse r satisfactry cmpletin f a higher level mathematics curse + ENG102 First-Year Cmpsitin (3) OR + ENG108 First-Year Cmpsitin fr ESL (3) OR + ENG111 Technical and Prfessinal Writing (3) Semester 7 Spring Credits: SGT220 Operating Rm Practicum III 3 + SGT225 Operating Rm Practicum IV 3 + SGT260 Surgical Prcedures III 2 + SGT275 Certificatin Examinatins Preparatin 2 (The fllwing curses are nly required fr AAS Degree) Any apprved general educatin curse in the Humanities, Arts and Design area 2 3 SOC101 Intrductin t Scilgy (3) OR PSY101 Intrductin t Psychlgy (3) 3 Semester 8 Summer Credits: 3 Nte: This curse is scheduled frm mid-may t mid-june. + SGT227 Operating Rm Practicum V 3 Surgical Technlgy 9 December

10 CERTIFICATE OF COMPLETION / ASSOCIATE OF APPLIED SCIENCE DEGREE SURGICAL TECHNOLOGY PROGRAM OPTION II Credits: Optin II is fr students wh DO have a Certified Registered Central Service Technician (CRCST) certificatin thrugh the Internatinal Assciatin f Healthcare Central Service Material Management (IAHCSMM). Optin II is als fr students wh have successfully cmpleted the GateWay Cmmunity Cllege Hspital Central Services Certificate and may r may nt be certified thrugh IAHCSMM. Students wh have been admitted int Optin II are required t take Credit by Evaluatin fr five (5) credits thrugh the prgram directr in lieu f enrlling in HCS/SGT100 (5). HCC130 r HCC130AA-AF and HCC145 r HCC146 may be waived by GateWay Health Cre Curriculum Crdinatr ( ) based n relevant industry experience r equivalent r curse educatin. Semester 1 Fall (Prgram Prerequisites) Certificate & AAS Credits: 6-12 BIO160 Intrductin t Human Anatmy and Physilgy Lecture/Lab (4) OR + BIO201 Human Anatmy and Physilgy I (4) 4 Students selecting BIO201 and BIO202 OR BIO205 must cmplete the prerequisite curses BIO156 r BIO BIO156 Intrductry Bilgy fr Allied Health (4) OR + BIO181 General Bilgy (Majrs) I (4) OR BIO162 One year high schl bilgy with a grade f C r better (0) 0 4 Micrbilgy Cncepts fr Allied Health (2) OR + BIO205 Micrbilgy (4) 2 4 Semester 2 Spring (Prgram Prerequisites) Certificate & AAS Credits: BIO202 Human Anatmy and Physilgy II (4) PHY101 Intrductin t Physics MAT090 MAT091 MAT092 MAT093 Intrductry Algebra (5) OR Intrductry Algebra (4) OR Intrductry Algebra (3) OR Intrductry Algebra/Math Anxiety Reductin (5) OR Satisfactry scre n District Placement exam OR Satisfactry cmpletin f a higher level mathematics curse 0 5 Semester 3 Fall Credits: HCC/RES109 CPR fr Health Care Prvider (0.5) OR Prf f current American Heart Assciatin Health Care Prvider CPR card (0) HCC130 HCC130AA HCC130AB HCC130AC HCC130AD HCC130AE HCC130AF Fundamentals in Health Care Delivery (3) OR Health Care Tday (0.5) and Wrkplace Behavirs in Health Care (0.5) and Persnal Wellness and Safety (0.5) and Cmmunicatin and Teamwrk in Health Care Organizatins (0.5) and Legal Issues in Health Care (0.5) and Decisin Making in the Health Care Setting (0.5) ) OR Permissin f GateWay Health Cre Curriculum Crdinatr 0 3 Surgical Technlgy 10 December

11 Semester 3 (cntinued) HCC145 HCC146 + RDG100AB Medical Terminlgy fr Health Care Wrkers (3) OR Cmmn Medical Terminlgy fr Health Care Wrkers (2) OR Permissin f GateWay Health Cre Curriculum Crdinatr 0 3 Successful Cllege Reading - Ntetaking and Studying fr Success (1) OR Curse may be waived by prgram directr if student has cmpleted a bachelr s degree r higher (0) HCS101/SGT101 Medical Terminlgy fr Surgical Services 1 + HCS102/SGT102 Basic Surgical Instrumentatin fr Surgical Services 2 + SGT135 Instrument Handling I 1 (The fllwing curses are nly required fr AAS Degree) + ENG101 First-Year Cmpsitin (3) OR + ENG107 First-Year Cmpsitin fr ESL (3) 3 + COM Any apprved general educatin curse frm the Oral Cmmunicatin area; except COM225 Public Speaking 3 Semester 4 Spring Credits: HCS152/SGT152 Advanced Surgical Instruments fr Surgical Services 2 + SGT155 Instrument Handling II 1 + SGT156 Hspital Central Service Practicum fr Surgical Technlgy 1 + SGT165 Surgical Prcedures I 4 + SGT180 Pharmaclgy fr Surgical Technlgy I 1 (The fllwing curses are nly required fr AAS Degree) + CRE101 Cllege Critical Reading (3) OR + CRE111 Critical Reading fr Business and Industry (3) OR Equivalent as indicated by assessment 0 3 SOC101 Intrductin t Scilgy (3) OR PSY101 Intrductin t Psychlgy (3) 3 Semester 5 Summer (Optinal) Credits: HCS154 Hspital Central Service Practicum 0 7 This semester is ptinal fr SGT students. Only thse seeking t cmplete the Certificate f Cmpletin in Hspital Central Services (5311) and t be eligible t sit fr the Certified Registered Central Service Technician (CRCST) certificate exam frm the Internatinal Assciatin f Healthcare Central Service Material Management (IAHCSMM) shuld take HCS154. This curse is nly ffered in the Summer fr SGT students. Surgical Technlgy 11 December

12 Semester 6 Fall Credits: SGT200 Operating Rm Practicum l 1 + SGT205 Operating Rm Practicum II 2 + SGT210 Surgical Prcedures II 4 + SGT215 Pharmaclgy fr Surgical Technlgy II 1 (The fllwing curses are nly required fr AAS Degree) + MAT120 Intermediate Algebra (5) OR + MAT121 Intermediate Algebra (4) OR + MAT122 Intermediate Algebra (3) OR Equivalent curse r satisfactry cmpletin f a higher level mathematics curse + ENG102 First-Year Cmpsitin (3) OR + ENG108 First-Year Cmpsitin fr ESL (3) OR + ENG111 Technical and Prfessinal Writing (3) Semester 7 Spring Credits: SGT220 Operating Rm Practicum III 3 + SGT225 Operating Rm Practicum IV 3 + SGT260 Surgical Prcedures III 2 + SGT275 Certificatin Examinatins Preparatin 2 (The fllwing curse is nly required fr AAS Degree) Any apprved general educatin curse in the Humanities, Arts and Design area 2 3 Semester 8 Summer Credits: 3 Nte: This curse is scheduled frm mid-may t mid-june. + SGT227 Operating Rm Practicum V 3 Prgram Ntes: Due t the requirements f the prgram accrediting bdy, the curse f study requires many hurs f classrm and clinical time. Please see the Center fr Curriculum & Transfer Articulatin fr the full descriptins f prgram requirements and recmmended sequence. Curriculum - Prgrams at GateWay Majr: 5673 Certificate f Cmpletin ttal prgram credits: Majr: 3673 Assciates f Applied Science ttal prgram credits: All infrmatin published is subject t change withut ntice. Every effrt has been made t ensure the accuracy f infrmatin presented, but based n the dynamic nature f the curricular prcess, curse and prgram infrmatin is subject t change in rder t reflect the mst current infrmatin available. Surgical Technlgy 12 December

13 SURGICAL ROTATION CASE REQUIREMENTS Surgical Specialty Ttal # f Cases Required Minimum # f First Scrub Required Cases Maximum # f Secnd Scrub Cases that can be applied twards 120 Cases General Surgery Surgical Specialties: Cardithracic ENT Eye GU Neur Ob-Gyn Oral/Maxillfacial Orthpedics Peripheral vascular Plastics Prcurement/ Transplant Diagnstic Endscpy: Brnchscpy Clnscpy Cystscpy EGO ERCP Esphagscpy Laryngscpy Panendscpy Sinscpy Ureterscpy 10 Diagnstic endscpy cases may be applied twards the secnd scrub cases! Labr & Delivery 5 Vaginal delivery cases may be applied twards the secnd scrub cases. 5 Ttals The ttal number f cases the student must cmplete is Students are required t cmplete 30 cases in General Surgery. Twenty f the cases must be in the First Scrub Rle. 3. Students are required t cmplete 90 cases in varius surgical specialties. Sixty f the cases must be in the First Scrub Rle and evenly distributed between a minimum f 4 surgical specialties. Fr example (Orth 5 cases, GYN/OB 15 cases, GU (urlgy) 15 cases, Plastics 15 cases, Oral/Maxillfacial 5, ENT 5 Must have 20 General Surgery.) 4. The surgical technlgy prgram is required t verify thrugh the surgical rtatin dcumentatin the students' prgressin in First and Secnd Scrubbing surgical prcedures f increased cmplexity as he/she mves twards entry level graduate abilities. 5. Diagnstic endscpy cases and vaginal delivery cases are nt mandatry. But up t 10 diagnstic endscpic cases and 5 vaginal delivery cases can be cunted twards maximum number f Secnd Scrub Rle cases. 6. Observatin cases must be dcumented, but d nt cunt twards the 120 required cases. 7. Cunting Cases Cases will be cunted accrding t surgical specialty. Examples: Trauma patient requires a splenectmy and repair f the Le Frt I fracture. Tw cases can be cunted and dcumented since the splenectmy is general and the repair f Le Frt I is ral-maxillfacial surgical specialty. Patient requires a breast bipsy fllwing by mastectmy. It is ne pathlgy, breast cancer, and the specialty is general surgery; therefre, it is cunted and dcumented as ne prcedure ne case. Surgical Technlgy 13 December

14 ESTIMATED PROGRAM COSTS The estimated cst fr the prgram is utlined belw. The student is respnsible fr prviding transprtatin, husing, and unifrms. The student will be respnsible fr csts f his/her natinal bard exam and state licensing in the final semester. Certificate f Cmpletin Prgram Tuitin* ( credit $86 a credit hr) 1... $ 3,354 3,999 Prgram Prerequisite Tuitin (10 20 credit $86 a credit hr) ,720 Restrictive Elective Tuitin (0 7 credit $86 a credit hr) Registratin fees ($15 per semester 8 semesters) Curse / Lab Fees... 1,350 Equipment / Supplies Bks (csts fr prerequisites and cre classes)... 3,193 Other Csts: License/Certificatin, Pre-Clinical Health & Safety Requirements, etc Ttal Estimated Csts $ 9,359 12,131 AAS Degree Prgram Tuitin* ( credit $86 a credit hr) 1... $ 3,354 3,999 Prgram Prerequisite Tuitin (10 20 credit $86 a credit hr) ,720 General Educatin Tuitin (17 23 credit $86 a credit hr) ,462 1,978 Restrictive Elective Tuitin (0 7 credit $86 a credit hr) Registratin fees ($15 per semester 8 semesters) Curse / Lab Fees... 1,350 Equipment / Supplies Bks (csts fr prerequisites and cre classes)... 3,193 Other Csts: License/Certificatin, Pre-Clinical Health & Safety Requirements, etc Out-f-Cunty residents pay $383* / Out-f-State residents pay $327** a credit hr 1 Ttal Estimated Csts $ 10,821 14,109 * Rates are set accrding t Arizna Revised Statute. Applies nly t cunties with n cmmunity clleges. ** Accrding t Arizna Revised Statute, F, "A persn wh is a member f an Indian tribe recgnized by the US Department f the Interir whse reservatin land lies in this state and extends int anther state and wh is a resident f the reservatin is entitled t classificatin as an in-state student." Therefre, unclassified and ut f state surcharges d nt apply t such students. Students must als plan n the expense f driving t clinical lcatins acrss the metrplitan Phenix and utlying areas. Several clinical affiliates are nt n bus rutes s ne s wn private transprtatin vehicle is necessary. 1 Tuitin and fees are set by the Maricpa Cmmunity Cllege Gverning Bard and apprved by the State Bard f Directrs fr Cmmunity Clleges; all fees are subject t change. Tuitin is higher fr nn-cunty residents; visit fr mre infrmatin. 2 Other Prgram Csts may be less r mre than listed based n a student s individual health recrd in respect t being in cmpliance with the immunizatin and safety requirements fr the clinical experience. IMPORTANT Tuitin/registratin fees are all due 35 days prir t the start date f each semester. If 34 days r less, all fees are due at the time f registratin r yu will be drpped frm yur classes and lse yur seat in the prgram fr nn-payment. Surgical Technlgy 14 December

15 IMMUNIZATIONS, TESTING, AND BACKGROUND REQUIREMENTS IMMUNIZATION AND TB TESTING REQUIREMENTS All health and safety is nw cmpleted digitally. The health and safety requirements are subject t change based n the requirements f ur clinical partners. Once a student has been accepted int a prgram fr the start f an upcming semester, clinical requirements will be sent ut. MCCCD BACKGROUND CHECK POLICY REQUIREMENTS Students seeking admissin t an MCCCD Allied Health r Nursing Prgram (Prgram) will be required t btain a valid Level-One Arizna Department f Public Safety Fingerprint Clearance Card (FCC Card) AND a passing scre n an MCCCD backgrund check. This plicy precludes MCCCD faculty r staff frm assigning students t a clinical experience wh cannt meet the new requirements. Upn admissin t the prgram, students are required t present a cpy f the DPS card and apply fr the MCCCD Backgrund Check. Students bear the financial csts fr bth the MCCCD Backgrund Check and the AZ Fingerprint Clearance Card. Students will receive Infrmatin regarding the MCCCD Backgrund Check after admissin, but prir t the beginning f the prgram. We encurage students t apply fr the card early in the applicatin prcess. Please allw a minimum f eight weeks prcessing time fr the DPS Level-One Fingerprint Clearance card. The card is valid fr six years frm the date f issue. DRUG SCREENING Each student must g thrugh a preclinical drug screen prir t beginning the first clinical rtatin. Drug screening fr all Surgical Technlgy students is mandatry. The cst fr tests will be the respnsibility f the student. The urine drug screen will test fr alchlic beverages, illegal drugs, r drugs that may impair judgment while in the clinical agency. If the drug test is psitive fr the illegal drugs, the student will nt be able t cntinue in the prgram. Readmissin is at the discretin f the cllege and the prgram. Sme clinical sites als require screening fr nictine. Students wh test psitive fr nictine may nt be able t be placed at certain clinical sites, but are nt excluded frm the prgram. Randm drug screening is at the discretin f the clinical site during the student s clinical experience. HCS ADVANCED PLACEMENT FOR THE SURGICAL TECHNOLOGY PROGRAM This is a Selective Admissins prgram. The students admitted t the Surgical Technlgy prgram are selected by the Selective Admissins ffice n a first cme, first serve basis The surgical technlgy candidate wh is a GateWay Cmmunity Cllege Hspital Central Service graduate frm spring 2017 chrt and future and has all required all pre-requisites cmplete is eligible fr advanced placement int the surgical technlgy prgram waiting list n a first cme, first serve basis. The first 5 students admitted t each c-hrt after 2 Veteran s being admitted will be thse electing the Surgical Technlgy prgram and having successfully cmpleted the Hspital Central Service prgram with all pre-requisites cmplete per the Selective Admissins Office beginning in Surgical Technlgy 15 December

16 REQUIRED TEXT BOOKS Inspecting Surgical Instruments, ISBN: $ *Delmar, Surgical Technlgy fr the Surgical Technlgist, 4th editin, with mind tap and access cde. ISBN fr the bundle: ISBN: Cengage Publishing $ Surgical Instrumentatin 2nd Editin, Nemitz; ISBN: $97.00 Surgical Equipment & Supplies 2nd Editin, Rutherfrd, ISBN: $ Pharmaclgy fr Surgical Technlgy 4th Editin, Snyder & Keegan, ISBN: $ th Editin Bxed Curse (this cntains a textbk and a wrk bk) IAHCSMM.rg $ Ttal $ Side Nte: If yu were t purchase The Delmar Bk Bundle bks separately; here are their csts: Mind tap access cde withut bundle; ISBN: $ Delmar Text withut bundle, ISBN: $ Study Guide Lab Manual withut bundle: ISBN $94.25 Central Service Technical Manual, 8th Editin (IAHCSMM.rg) (prvided by prgram) $85.00 Surgical Technlgy 16 December

17 FREQUENTLY ASKED QUESTIONS Is this an accredited prgram? The GateWay Cmmunity Cllege Surgical Technlgy Prgram is accredited by the Cmmissin n Accreditatin f Allied Health Educatin Prgrams (CAAHEP.rg). Can I apply previusly earned cllege credits t this prgram f study? Previusly earned cllege credits may be acceptable twards degree/certificate requirements; hwever they shuld be checked fr equivalency by the GateWay Cmmunity Cllege Prgram Adviser. If I am a military veteran, what will GateWay Cmmunity Cllege d fr me t be accepted int the Surgical Technlgy prgram? Selective Admissins in Admissins and Recrds will insure that the first 2 seats f each prgram start will be held fr military veterans. A cpy f yur DD214 is required. If I have a criminal recrd, will that prhibit me frm being able t enrll in this career? It is pssible that withut prper clearance yu may nt be able t enrll if yu have a criminal recrd. Our clinical agreements with the healthcare facilities require that ur students receive a Level-ne Fingerprint Clearance Card issued by the Arizna Department f Public Safety. Additinally, a student must nt be listed n the Federal Gvernment s Office f the Inspectr General s Exclusin List. Students wh are unable t btain either f these clearances will be prhibited frm attending their clinical experience. Hw many students are admitted int the prgram? The Surgical Technlgy Prgram admits 20 students each Fall as permitted by the Accreditatin Review Cuncil n Educatin in Surgical Technlgy and Surgical Assisting and the facilities in the cmmunity. Can I get financial aid r a schlarship? Financial assistance is available t eligible GateWay Cmmunity Cllege students in the frm f grants, schlarships, emplyment r lans. Students may receive assistance frm nly ne funding surce, r aid may be ffered in a package frm multiple surces. This depends n student eligibility, level f need, packaging plicy, and availability f funds. Additinal infrmatin is available frm the Office f Financial Aid Services ( ). I live utside Maricpa Cunty. Is it pssible fr me t g t a clinical site clser t where I live? The surgical technlgy prgram des have clinical partners utside Maricpa Cunty. The student s clinical experience must be slely arranged by the Clinical Crdinatr at GateWay Cmmunity Cllege. Arrangements ther than thse made by the Clinical Crdinatr will nt be acknwledged due t the plicy f the prgram s accreditatin. All students interested in a clinical site lcatin utside f Maricpa Cunty may submit a written request fr a specific hspital clinical practicums site thrugh the Clinical Crdinatr. ACCREDITATION GateWay Cmmunity Cllege is a Maricpa Cmmunity Cllege, accredited by the Higher Learning Cmmissin, a Cmmissin f the Nrth Central Assciatin f Clleges and Schls (30 Nrth LaSalle St, Suite 2400, Chicag, IL , ), and its curses are apprved by the Scial Security Administratin fr Veterans training. This schl is authrized under federal law t enrll nnimmigrant alien students. The GateWay Surgical Technlgy Prgram is accredited by the Cmmissin n Accreditatin f Allied Health Educatin Prgrams (CAAHEP) upn the recmmendatin f the Accreditatin Review Cuncil n Educatin in Surgical Technlgy and Surgical Assisting (ARC/STSA). Surgical Technlgy 17 December

18 POLICIES, RULES, REQUIREMENTS, AND REGULATIONS COMPLIANCE Plicies, curses, prgrams, fees, and requirements may be suspended, deleted, restricted, supplemented, r changed thrugh actin f the Gverning Bard f the Maricpa Cmmunity Clleges. The Maricpa Cmmunity Clleges reserves the right t change, withut ntice, any materials, infrmatin, curriculum, requirements, and regulatins. Admissin r graduatin frm any Allied Health prgram at GateWay Cmmunity Cllege des nt guarantee the student s prfessinal certificatin, licensure, r emplyability. The student must cmply with legal requirements f the prfessin. This may include prvisins frm Arizna Revised Statutes (sectins B and C) regarding the denial f a fingerprint clearance card r being listed n the US gvernment s Office f Inspectr General s Exclusin List. Students enrlled in the prgram will have learning experiences in a health care setting where they will have access t cnfidential infrmatin. Prir t beginning any clinical studies the students will be asked t sign an agreement t adhere t the requirements f thse clinical sites and applicable laws, including the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). Students with related health care experiences nt listed in the Prgram (Health Cre Curriculum curses) Prerequisites/C-requisite ptins, may request an evaluatin fr curse cmpetency equivalence by cntacting GateWay's Health Cre Curriculum Crdinatr Char Bautista by calling r ing her at bautista@gatewaycc.edu. COLLEGE COMMUNICATION The fllwing infrmatin is very imprtant s yu d nt miss any ntices: We cmmunicate with students strictly thrugh yur Maricpa Cllege , nt yur persnal accunt. We have a district-wide Ggle pwered system. This system is the way we send all fficial Cllege cmmunicatins cncerning selective admissins, class enrllment, financial aid, tuitin due dates and ther imprtant student infrmatin. All students will need t check their new student regularly r frward the new student t a persnal t ensure that all fficial cllege cmmunicatin is received. Students may access their new accunts directly frm their Student Center nce they lg in at my.maricpa.edu. 1st sectin Student Cmmunicatin Center. The benefits t yu include: Quicker respnse Cnvenience. Yu can receive & read even if ut-f-twn Saves trees! G t my.maricpa.edu & lg in t yur accunt. Click n create an accunt in the paragraph abve the picture f the students t set up yur student accunt. Yu may edit yur infrmatin, such as address, phne, etc. here als if yu need t. This is a self-service fr students, which includes registering fr classes, adding/drpping classes, making payments, printing yur class schedules, viewing financial aid & viewing yur grades. If yu have any technical issues, please call Surgical Technlgy 18 December

19 CONTACT INFORMATION If yu have any questins abut the enclsed prgram material, please feel free t cntact any f the fllwing prgram cntacts: Susan Tmé RN., MS, CNOR, Prgram Directr/ Phne: tme@gatewaycc.edu Brandy Thmpsn RN, M.Ed., CNOR, CST, Clinical Crdinatr/ Phne: thmpsn@gatewaycc.edu Carline Delgad, Health Sciences Academic Advisr / Phne: delgad@gatewaycc.edu Lucy Granill, Health Sciences Academic Advisr / Phne: luciella.granill@gatewaycc.edu Jennifer Brwn, Health Sciences Academic Advisr / Phne: jennifer.brwn@gatewaycc.edu Den Criddle, Health and Safety Administratr / Phne: criddle@gatewaycc.edu Questins regarding Health and Safety Immunizatins; send t: mce-cp@gatewaycc.edu Surgical Technlgy 19 December

20 HOW TO APPLY & ENROLL STEP 1: STEP 2: STEP 3: GET ADMITTED Create MEID Accunt and Apply fr Admissins maricpa.edu/admissins Prvide prf f identity t the cllege at which yu applied. Fr tuitin purpses, verify yur residency status by prviding a gvernment issued ID. Submit prir educatin (if applicable) i.e. high schl and/r cllege/university fficial transcript. Undecided n a majr? Cnnect with Cunseling and Career Services at yur cllege. Visit the campus t familiarize yurself with the services and resurces. Cmplete the FAFSA and schlarship applicatins at: maricpa.edu/paying-fr-cllege. TAKE THE PLACEMENT TEST Prepare, Study, and Schedule Test maricpa.edu/testing Prepare by reviewing the sample questins at maricpa.edu/testing. Placement test will ensure apprpriate level f classes fr enrllment. The Placement Test is nt a pass/fail exam. The Placement Test is untimed and FREE. Bring yur gvernment issued pht ID n the day f testing. T review yur test scre results, ask fr a Curse Placement Chart. GET ENROLLED Seek Academic Advisement maricpa.edu/advisement Advisrs will help with identifying curses and creating an Educatinal Plan t meet yur academic gals. Meet with a Health Sciences Academic Advisrs every semester prir t class registratin. The Health Sciences Academic Advisrs are available by phne, , r in persn at the CH Center fr Health Careers Educatin Building, n the nrth side f campus during the fllwing business hurs: Walk-in basis Fr an appintment call Mndays: 8 a.m. t 5 p.m. Wednesdays: 8 a.m. t 1:30 p.m. Thursdays: 8 a.m. t 5 p.m. Tuesdays & Fridays by appintments. Decrease yur waiting time by scheduling an appintment. (During the Summer, cllege is clsed n Fridays) Befre yu meet with an advisr, we recmmend yu check ut the current Catalg t learn mre abut the prgrams that interest yu. Let yur advisr knw if yu have any questins r cncerns. If yu have taken a class fr cllege credit and yu are interested in transferring credits t GateWay, yu may better prepare fr yur meeting if yu bring a cpy f yur transcripts t review with yur advisr and then: Surgical Technlgy 20 December

21 Arrange t have yur fficial transcripts (frm all clleges & schls previusly attended) sent t: Attn: Admissins & Recrds 108 N 40th Street Phenix, AZ Bring a cpy f yur transcripts t review with yur advisr. Yur advisr can help yu chse curses that will apply t mst degrees and give yu an intrductin int yur areas f interest. Register fr Classes maricpa.edu/register Register fr classes early t ensure the best schedule, maximize financial aid ptins, and t get prepared fr a successful semester. Knw when yur tuitin is due. Attend New Student Orientatin maricpa.edu/new-student-rientatin All new t cllege students must attend New Student Orientatin. Research shws that thse wh participate, have higher rates f attaining their gals. STEP 4: STEP 5: STEP 6: PAY TUITION AND FEES Explre Payment Optins maricpa.edu/paying-fr-cllege Mnitr yur Student Center fr current balance and pay n r befre due date. Explre paying fr cllege at maricpa.edu/paying-fr-cllege. Cmplete the Free Applicatin fr Federal Student Aid (FAFSA) at fafsa.gv. Explre cllege websites fr schlarships, such as the Presidents Schlarship and mre. REVIEW PROGRAM REQUIREMENTS Each f ur Health Science prgrams has unique requirements. We strngly encurage yu t review the prgram packets and the current catalg fr any specialties that yu might cnsider. These resurces will prvide yu with detailed prgram infrmatin regarding prerequisite curses and applicatin prcedures. PROGRAM APPLICATION The Surgical Technlgy Prgram infrmatin packet cntains detailed infrmatin regarding the necessary pre-requisites t enrll. Please be sure t review this infrmatin t ensure that yur applicatin materials are cmplete and received at the Special Admissins ffice. Deadlines are available thrugh the Admissins and Recrds Office, Selective Admissins. Yu will receive ntificatin f yur acceptance via . This will arrive thrugh the Maricpa accunt set up when yu received yur MEID. S yu will want t check this accunt regularly, r have it frwarded t an accunt which yu d check ften. Keep yur cntact infrmatin current with GateWay Cmmunity Clleges Admissins and Recrds department, Selective Admissins Office: Carmel DeVra; devra@gatewaycc.edu; telephne: Please return yur applicatin t: GateWay Cmmunity Cllege, 108 N. 40th Street, Phenix, AZ , attentin: Selective Admissins r by selective admissins@gatewaycc.edu. Surgical Technlgy 21 December

22 STUDENT SERVICES The fllwing are sme f the services available t students. Advising The Health Sciences Academic Advisrs are available by phne, , r in persn at the CH Center fr Health Careers Educatin Building, n the nrth side f campus during the fllwing business hurs: Walk-in basis Fr an appintment call Mndays: 8 a.m. t 5 p.m. Wednesdays: 8 a.m. t 1:30 p.m. Thursdays: 8 a.m. t 5 p.m. Tuesdays & Fridays by appintments. Decrease yur waiting time by scheduling an appintment. (During the Summer, cllege is clsed n Fridays) Bkstre Available are textbks and supplies fr classes, call Yu may visit their website at: and selecting Cllege Textbks. Cunseling Academic, persnal, r career cunseling available. Call Emplyment Upn cmpletin f the Health Unit Crdinatr Prgram, cntact the Career & Re-Entry Services, at fr assistance. Financial Aid Available fr qualified students. Cntact the Financial Aid Office at r visit website: Student Assessment Center Services include instructr makeup exams, the English, Math, and Reading ASSET r COMPASS placement tests, and selected instruments required fr acceptance int the Health Science r Nursing prgrams. Call fr specific days and times tests are available. Tutring Assistance Available thugh the Learning Center, Fr a cmplete listing f student services, please refer t the cllege catalg, r visit GateWay s website: r call cllege infrmatin at Surgical Technlgy 22 December

23 ADMISSION APPLICATION FOR SURGICAL TECHNOLOGY PROGRAM GATEWAY COMMUNITY COLLEGE 108 N 40th St / Phenix, AZ / Please print clearly I PLAN TO BEGIN THE PROGRAM IN: Fall 2018 Fall 2019 LEGAL NAME (LAST) (FIRST) (MIDDLE) ADDRESS (STREET) (CITY) (STATE) (ZIP) FORMER NAME(S) which may appear n transcript HOME PHONE NUMBER CELL PHONE NUMBER E - MAIL ADDRESS STUDENT ID NUMBER PERSON TO NOTIFY IN CASE OF EMERGENCY PHONE ADDRESS Infrmatin Release FERPA: D yu give permissin fr the cllege t release directry infrmatin relative t yur enrllment (as per the Family Educatin Rights and Privacy Act f 1974)? Yes N Are yu an United States Veteran? Yes N Attach a cpy f DD214 Admissin Applicatin Checklist attached and signed ff by advisr and student? Yes N PLEASE RETURN YOUR APPLICATION TO: GATEWAY COMMUNITY COLLEGE / 108 N 40th ST / PHOENIX, AZ Surgical Technlgy 23 December

24 PREVIOUS COLLEGES OR TECHNICAL SCHOOLS ATTENDED: NAME OF INSTITUTION CITY AND STATE DATE OF ENTRANCE DIPLOMA OR DEGREE RECEIVED DATE OF LEAVING COLLEGE MAJOR NAME OF INSTITUTION CITY AND STATE DATE OF ENTRANCE DIPLOMA OR DEGREE RECEIVED DATE OF LEAVING COLLEGE MAJOR NAME OF INSTITUTION CITY AND STATE DATE OF ENTRANCE DIPLOMA OR DEGREE RECEIVED DATE OF LEAVING COLLEGE MAJOR Attach separate sheet if additinal space is needed MILITARY: Are yu a member f the US Armed Frces, a frmer member f the US Armed Frces, r a dependent f a member f the US Armed Frces? If yes, select all that apply: I am a current member f the US Armed Frces Yes N I am a dependent f a member f the US Armed Frces Yes N I am a frmer member f the US Armed Frces Yes N CERTIFICATION: I certify that the abve answers are true, crrect, and cmplete. I understand that any falsificatin r intentinal misrepresentatin f infrmatin n this applicatin may be cause fr dismissal frm the Surgical Technlgy Prgram and frm the cllege. I understand that it is the respnsibility f the student t maintain accurate cntact infrmatin with the Admissins and Recrds Department. Failure t prvide this infrmatin may preclude the student frm being admitted int the Surgical Technlgy Prgram. SIGNATURE DATE Surgical Technlgy 24 December

25 WAIVER OF LICENSURE / CERTIFICATION DISCLAIMER Yur admissin t GateWay Cmmunity Cllege Surgical Technlgy Prgram is n guarantee that yu will receive an Assciate f Applied Science Degree r a Certificate f Cmpletin frm the cllege. Cmpleting the Surgical Technlgy Prgram is nt the sle criterin fr btaining natinal certificatin. Requirements fr natinal certificatin are the exclusive respnsibility f the Liaisn Cuncil n Certificatin fr the Surgical Technlgist. I have read and understand the Admissin Applicatin Disclaimer. SIGNATURE DATE STUDENT ID NUMBER This disclaimer will becme part f yur Surgical Technlgy Prgram recrds. Surgical Technlgy 25 December

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27 Allied Health STUDENT HEALTH AND SAFETY DOCUMENTATION CHECKLIST Name: Student ID: Date: Cell Phne: Hme Phne: Must attach dcumentatin (cpies f lab reprts, immunizatin recrds, CPR card, etc.) as indicated fr each f the fllwing t be in cmpliance with Maricpa Cmmunity Cllege requirements. Fingerprint clearance card, CPR certificatin and TB skin test must be current thrughut the semester f enrllment r duratin f practicum experiences. See Explanatin f Requirements in the Allied Health Shared Student Plicies handbk fr specific detail. Als, DO NOT have facilities initial r stamp anything n this checklist. A. MMR (Measles/Rubela, Mumps and Rubella): Requires dcumented prf f a psitive IgG MMR titer r dcumented prf f One MMR series. 1. MMR vaccinatin: Dates: #1 #2 OR 2. Date & titer results: Measles: Mumps: Rubella: B. Varicella (Chickenpx): Requires dcumented prf f psitive IgG titer r dcumented prf f Varicella series. 1. Varicella vaccinatin dates: #1 #2 OR 2. Date & results f varicella IgG titer: Date: Result: C. Tetanus/Diphtheria/Pertussis (Tdap): Yu must prvide prf f a ne time Tdap vaccinatin and Td bster if 10 years r mre since Tdap vaccinatin 1. Tdap vaccine: Date: OR 2. Td bster: Date: D. Tuberculsis: Dcumentatin is required fr all tests. Fr individuals wh have nt received a TB test within the past year, will need t receive a 2 Step TB test. This cnsists f tw separate TB test; an initial TB skin test and a secnd TB skin test 1 3 weeks apart. After cmpletin f the 2 step, an annual update f TB skin test is sufficient. If yu have a psitive skin test, prvide dcumentatin f a QuantiFERON test r negative chest X ray and annual dcumentatin f a TB disease free status. Mst recent skin testing r bld test must have been cmpleted within the previus six (6) mnths. 1. Negative 2 step TB Skin Test (TBST), including date f administratin, date read, result, and name and signature f healthcare prvider. Initial Test (#1) Date: Date Read: Results: Negative r Psitive Bsted Test (#2) Date: Date Read: Results: Negative r Psitive 27

28 Allied Health STUDENT HEALTH AND SAFETY DOCUMENTATION CHECKLIST 2. Annual 1 step TBST (accepted nly frm cntinuing students wh have submitted initial 2 step TBST) OR Date: Date Read: Results: Negative r Psitive 3. Negative bld test (Either QuantiFERON r TSpt) OR QuantiFERON Date: T Spt Date: 4. Negative chest X ray OR 5. Dcumentatin f a negative chest X ray (x ray reprt) r negative QuantiFERON result and cmpleted Tuberculsis Screening Questinnaire (available in CastleBranch). Date: E. Hepatitis B: Dcumented evidence f cmpleted series r psitive antibdy titer r signed declinatin frm. If yu have nt received any injectins, d nt get a titer. The secnd injectin f the series is 1 t 2 mnths after the first dse and the third injectin is 4 t 6 mnths after the first dse. Date Titer received: Results: Date f 1st injectin: Date f 2nd injectin: Date f 3rd injectin: OR HBV Vaccinatin Declinatin Attached F. Influenza: Dcumented evidence f influenza vaccinatin fr the current flu seasn r declinatin. Date f Injectin: OR Signed Declinatin Frm Attached G. CPR Card (Healthcare Prvider level): An fficial certificatin is required (In Persn r Hybrid training curses are nly accepted) Date Card Issued: Expiratin Date: H. CastleBranch Clearance Dcument: Passed Page: Expiratin Date: Instructins nce alerted f passing backgrund Under yur "My Dcument area" g t "Backgrund Check" area, g t "Clearance Dcument" area f yur prfile and click the "dwnlad" buttn t print yur "ONE PAGE Passed Page" please d nt submit yur entire reprt frm yur backgrund check. 28

29 Allied Health STUDENT HEALTH AND SAFETY DOCUMENTATION CHECKLIST I. Clearance fr Participatin in Clinical Practice It is essential that allied health students be able t perfrm a number f physical activities in the clinical prtin f their prgrams. At a minimum, students will be required t lift patients and/r equipment, stand fr several hurs at a time and perfrm bending activities. Students wh have a chrnic illness r cnditin must be maintained n current treatment and be able t implement their assigned respnsibilities. The clinical allied health experience als places students under cnsiderable mental and emtinal stress as they undertake respnsibilities and duties impacting patients lives. Students must be able t demnstrate ratinal and apprpriate behavir under stressful cnditins. Please d nt attached r turn in yur actual physical infrmatin frm yur visit. I believe the applicant WILL OR WILL NOT be able t functin as an allied Health student as described abve. If nt, explained: Health Care Prvider Frm: Reviewed and signed by a licensed health care prvider (M.D., D.O., nurse practitiner, r physician s assistant) within the past six (6) mnths. Licensed Healthcare Examiner (M.D., D.O., N.P., P.A.): Print Name: Title: Signature: Date: Address: City: State: Zip Cde: 29

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31 SGT ADMISSION APPLICATION CHECKLIST ADVISOR REVIEW Last Name First Name Student ID Date The fllwing prerequisites must be cmpleted prir t submitting yur applicatin. In rder fr a curse t satisfy the prerequisite requirements, students must receive a minimum grade f C r 2.0. Applicatins withut this Advisr Review frm cmpleted and signed by a GateWay Cmmunity Cllege Healthcare Advisr will nt be accepted. Curse BIO160 + BIO201 + BIO202 Curse Title Credits Required Intrductin t Human Anatmy and Physilgy (4) OR Human Anatmy and Physilgy I (4) AND Human Anatmy and Physilgy II (4) 4 8 Cllege Students selecting BIO201 and BIO202 r BIO 205 must cmplete the prerequisite curses BIO156 r BIO181. BIO156 BIO181 BIO162 + BIO205 + MAT090 + MAT091 + MAT092 + MAT093 Intrductry Bilgy fr Allied Health (4) OR General Bilgy (Majrs) I (4) OR One year high schl bilgy with a grade f C r better (0) 0 4 Micrbilgy Cncepts fr Allied Health (2) OR Micrbilgy (4) 2 4 Develpmental Algebra (5) OR 0 5 Intrductry Algebra (4) OR Intrductry Algebra (3) OR Intrductry Algebra/Math Anxiety Reductin (5) OR Satisfactry scre n District Placement exam OR Satisfactry cmpletin f a higher level mathematics curse + PHY101 Intrductin t Physics 4 Semester Cmpleted r Enrlled Grade Level One Fingerprint Clearance Card (cpy required) American Heart Assciatin Healthcare Prvider CPR Card Expiratin Date Expiratin Date MCCCD Plicy Backgrund Check Acknwledgement (cpy attached) Student Signature Student Name (printed) Date Advisr Signature Advisr Name (printed) Date Surgical Technlgy 31

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33 Allied Health and Nursing Prgrams Maricpa Cunty Cmmunity Cllege District Summary f Criminal Backgrund Check Requirements effective September 1, 2011 (Student Cpy) Overview f the Requirements In rder fr students t be admitted t r maintain enrllment in gd standing in Maricpa Cunty Cmmunity Cllege District s ( MCCCD ) Allied Health and Nursing prgrams ( Prgrams ) beginning n September 1, 2011, students must prvide with their applicatin t a Prgram all f the fllwing: A cpy f an Arizna Department f Public Safety Level One Fingerprint Clearance Card ( Card ). Students are required t pay the cst f applying fr the Card. Cards that are NOT Level One status will nt be accepted. An riginal versin f the Criminal Backgrund Check Disclsure Acknwledgement frm attached t this Summary signed by the student. At all times during enrllment in a Prgram, students must btain and maintain BOTH a valid Level One Fingerprint Clearance Card and passing dispsitin n supplemental backgrund check perfrmed by MCCCD authrized vendr. Admissin requirements related t backgrund checks are subject t change as mandated by clinical experience partners Implementatin f the Requirements 1. Students that are denied issuance f a Card may be eligible fr a gd cause exceptin thrugh the Arizna Department f Public Safety. It is the student s respnsibility t seek that exceptin directly with the department. Until the student btains a Card and meets the ther requirements fr admissin, he r she will nt be admitted t a Prgram. 2. Students admitted t a Prgram whse Card is revked r suspended must ntify the Prgram Directr immediately and the student will be remved frm the Prgram in which they have been admitted r are enrlled. Any refund f funds wuld be made per MCCCD plicy. 3. The Criminal Backgrund Check Disclsure Acknwledgement directs students t disclse n the data cllectin frm f the MCCCD authrized backgrund check vendr all f the requested infrmatin as well as any infrmatin that the backgrund check may discver. Hnesty is imprtant as it demnstrates character. Lack f hnesty will be the basis fr denial f admissin r remval frm a Prgram if the infrmatin that shuld have been disclsed but was nt wuld have resulted in denial f admissin. Failure t disclse ther types f infrmatin cnstitutes a vilatin f the Student Cde f Cnduct and may be subject t sanctins under that Cde. Students have a duty t update the infrmatin requested n the [backgrund check vendr] data cllectin frm prmptly during enrllment in a Prgram. The [backgrund check vendr] data cllectin frm may ask fr the fllwing infrmatin but the frm may change frm time t time: Legal Name Maiden Name Other names used Scial Security Number Date f Birth Arrests, charges r cnvictins f any criminal ffenses, even if dismissed r expunged, including dates and details. Pending criminal charges that have been filed against yu including dates and details. Participatin in a first ffender, deferred adjudicatin r pretrial diversin r ther prbatin prgram r arrangement where judgment r cnvictin has been withheld. The authrized MCCCD backgrund check vendr will be asked t pass r fail each student based n the standards f MCCCD s clinical experience partners that have established the mst stringent requirements. The sle recurse f any student wh fails the backgrund check and believes that failure may have been in errr is with the backgrund check vendr and nt MCCCD. Summary f Criminal Backgrund Check Requirements.dcx 33

34 Summary f Criminal Backgrund Check Requirements.dcx 34

35 (Student: Sign and Attach t Applicatin) ACKNOWLEDGEMENT OF CRIMINAL BACKGROUND CHECK REQUIREMENTS APPLICABLE TO STUDENTS SEEKING ADMISSION INTO ALLIED HEALTH OR NURSING PROGRAMS ON OR AFTER SEPTEMBER 1, 2011 In applying fr admissin t a Nursing r Allied Health prgram ( Prgram ) at the Maricpa Cunty Cmmunity Cllege District, yu are required t disclse n the Arizna Department f Public Safety (DPS) frm all required infrmatin and n the MCCCD authrized backgrund check vendr data cllectin frm any arrests, cnvictins, r charges (even if the arrest, cnvictin r charge has been dismissed r expunged), r participatin in first ffender, deferred adjudicatin, pretrial diversin r ther prbatin prgram n this frm. Additinally, yu must disclse anything that is likely t be discvered in the MCCCD supplemental backgrund check that will be cnducted n yu. Please cmplete the DPS frm, the MCCCD authrized backgrund check vendr frm and any clinical agency backgrund check frm hnestly and cmpletely. This means that yur answers must be truthful, accurate, and cmplete. If yu knw f certain infrmatin yet are unsure f whether t disclse it, yu must disclse the infrmatin, including any arrest r criminal charge. Additinally, By signing this acknwledgement, yu acknwledge the fllwing: I understand that I must submit t and pay any csts required t btain a Level One Fingerprint Clearance Card and an MCCCD supplemental criminal backgrund check. I understand that failure t btain a Level One Fingerprint Clearance Card will result in a denial f admissin t a Prgram r remval frm it if I have been cnditinally admitted. I understand that I must submit t and pay any csts required t btain an MCCCD supplemental backgrund check prir t the start f the class. I understand that failure t btain a pass as a result f the MCCCD supplemental criminal backgrund check will result in a denial f admissin t a Prgram r remval frm it if I have been cnditinally admitted. I understand that, if my Level One Fingerprint Clearance Card is revked r suspended at any time during the admissin prcess r my enrllment in a Prgram, I am respnsible t ntify the Prgram Directr immediately and that I will be remved frm the Prgram. I understand that a clinical agency may require an additinal criminal backgrund check t screen fr barrier ffenses ther than thse required by MCCCD, as well as a drug screening. I understand that I am required t pay fr any and all criminal backgrund checks and drug screens required by a clinical agency t which I am assigned. I understand that the bth the MCCCD supplemental r the clinical agency backgrund check may include but are nt limited t the fllwing: Natinwide Federal Healthcare Fraud and Abuse Databases Scial Security Verificatin Residency Histry Arizna Statewide Criminal Recrds Natinwide Criminal Database Natinwide Sexual Offender Registry Hmeland Security Search By virtue f the MCCCD supplemental backgrund check, I understand that I will be disqualified fr admissin r cntinued enrllment in a Prgram based n my criminal ffenses, the inability t verify my Scial Security number, r my being listed in an exclusinary database f a Federal Agency. The criminal ffenses fr disqualificatin may include but are nt limited t any r all f the fllwing: Scial Security Search Scial Security number des nt belng t applicant Any inclusin n any registered sex ffender database Summary f Criminal Backgrund Check Requirements.dcx 35