SURGICAL TECHNOLOGY PROGRAM APPLICATION

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1 SURGICAL TECHNOLOGY PROGRAM APPLICATION Dear Applicant: Thank you for your interest in Wharton County Junior College s Surgical Technology Program. Information on the program and the requirements necessary to apply for admission to the program are in this packet. The Surgical Technology Program is a one-year program that begins in August of each year. In order to apply and be considered for acceptance into the program the following items must be submitted by the last Thursday in May. Applications will continue to be accepted until a class is chosen. Application to Surgical Technology: Surgical Technology Program Application, Questionnaire, References and Technical Standards forms are to be completed and submitted to the Surgical Technology Department at the main campus in Wharton. Admission to WCJC: Applicant must meet the admission requirements to Wharton County Junior College. Admission to WCJC is a separate process from admission to the Surgical Technology program. Applicants must be eligible to register for courses at WCJC in order to be considered for admission to the Surgical Technology program. If you are NOT currently enrolled at WCJC, the WCJC application can be completed at ApplyTexas.org. A copy of the WCJC application or of acceptance should also be included with your application. Transcripts: Copy of High School Transcript or GED. Copy of College Transcript(s) from each college attended (if applicable) NOTE: The Surgical Technology Department will not be responsible for securing transcripts from the WCJC Registrar s Office. Texas Success Initiative (TSI): Applicants must have all components of Texas Success Initiative satisfied before submitting application to the Surgical Technology program. TSI status can be verified by contacting the WCJC Registrar s office. ACT (American College Test) Test Scores:. ACT scores with an 18+ in Reading and 17+ on the Composite. ACT may be either National or Local. No other test scores will be accepted. Scores cannot be older than five (5) years. For more information on testing, contact the Testing Center at ext Copy of current Driver s License References: Three jnames with complete mailing and complete addresses for references. Reference forms will be forwarded to the names provided. References must not be related to you. Hepatitis B Requirement: Documentation of at least one vaccine by the application deadline or provide a positive antibody (IgG) titer indicating proof of immunity. Series must be started by the application deadline. The series takes six months to complete. Information Session: Attend one information session prior to May deadline. The information sessions are scheduled for the second Monday of the month of November, December, January, February, March, April and May from 5:00-6:00 p.m. These sessions will be by appointment only. Please call for scheduling information sessions. If you have any questions or need more information, please call (979) or , ext Sincerely, Melissa R. Bruton Melissa R. Bruton Program Director

2 WHARTON COUNTY JUNIOR COLLEGE SURGICAL TECHNOLGY PROGRAM INFORMATION FOR APPLICANTS ACCEPTANCE Informative interviews are scheduled with qualified applicants. Once we have interviewed all qualifying applicants, the class will be selected. For you to be eligible for acceptance your file must be complete. We are limited to 16 students each year. Application to the program does not guarantee acceptance. CRIMINAL BACKGROUND CHECKS AND DRUG SCREENS Most clinical facilities require that criminal background checks and drug screens be completed prior to allowing students to participate in clinical training at their facilities. Applicants conditionally accepted into the Surgical Technology Program will be required to complete a criminal background check and drug screen. Final acceptance into the program is contingent upon a satisfactory background check and drug screen, which will be completed by an approved agency. The cost of the criminal background check and the drug screen will be at the applicant s expense. The estimated cost for the criminal background check is $ The estimated cost of the drug screen is $ Information regarding this process should be obtained from the Surgical Technology program. POSITIVE DRUG SCREEN An applicant with a positive drug screen will not gain acceptance into the program and will not be considered for admission in the future applicant pools. UNIFORMS Student uniforms are required. Information will be given to students during orientation. PHYSICAL EXAMINATION and IMMUNIZATIONS Due to Senate Bill 1177 effective September 1, 2012, the college must verify immunity by way of a titer for all healthcare students for the following: Varicella, Rubella, Rubeola, Mumps, and Hepatitis B. The student must also present an ADULT dose of TDap. Upon acceptance a physical examination by your physician with satisfactory results is required along with proof of immunizations. Final acceptance is contingent upon satisfactory results of your physical examination. The physical examination form will be ed with acceptance letters. The estimated cost to Certified Background for immunization tracking is approximately $35. All of the required documentation must be uploaded into Certified Background by the first day of class with the exception of titers and the remaining Hepatitis B immunizations that may not be available by the first day of class. Tetanus/Diphtheria MMR Hepatitis B Varicella Tuberculin (TB) Influenza (Flu) One dose within the last 10 years. Two doses required if born after 1956 or proof of serologic immunity. Documentation of at least two vaccines is required by the first day of class (if not already immune). Series takes six months to complete; series must be started prior to May 15th to be completed. A positive antibody (IgG) titer with lab results One of the following is required: 1 Step TB skin test OR if result is positive, provide a clear chest x-ray. The vaccine must be given before the last week in October. Flu vaccines are required by the clinical affiliates.

3 COST The approximate cost of the program is as follows: Term Tuition Books Misc. Uniforms/Shoes Graduation Fall See college catalog $900 $500 $150/$50 Spring See college catalog $350 $240 $50 Summer See college catalog $100 $50 WORK Due to the full time nature of this program, outside employment is discouraged. If one has to work no more than 20 hours per week is recommended. FINANCIAL AID All financial aid is handled through the Financial Aid Office at the main campus in Wharton or the CentraPlex Campus in Sugar Land. FBTC: (281) Sugar Land: (281) Ext Wharton: (979) Ext GRADES A C (2.0 GPA) average (75%) is required in each course to continue in the program. In some courses, a 75% TEST average is required. ATTENDANCE Only four (4) absences are allowed in fall and spring; three (3) absences in the summer. Three (3) tardies constitute one (1) absence. RELIGIOUS HOLIDAYS Religious Holidays must be requested prior to the beginning of each semester. HOURS Class time is full time Monday - Friday. Clinicals will start in early January. CPR Prior to class beginning, proof of American Heart Association Healthcare Provider CPR certification is required. Classes are available throughout the community; WCJC s EMS Department ( ), local hospitals, fire stations, and American Heart Association, etc. (MUST be American Heart Association Healthcare Provider ONLY. Recertification is required during the year if necessary to keep the certification current. ON-LINE CPR WILL NOT BE ACCEPTED. IT IS THE SOLE RESPONSIBILITY OF THE APPLICANT TO MAKE SURE THAT ALL REQUIRED PAPERWORK IS SUBMITTED TO THE SURGICAL TECHNOLOGY PROGRAM BY THE APPLICATION DEADLINE.

4 PRINT CLEARLY SURGICAL TECHNOLOGY PROGRAM APPLICATION Date Name Last First MI SS# Home Address City State Zip Code Home Phone Cell Phone Alternate Phone Address Date of Birth (optional) Name, address, and telephone number of person to be notified in case of an emergency: Do you have a High School Diploma or GED? Yes No Have you attended any Surgical Technology Program? Yes No If yes, name and address of Surgical Technology Program attended: Reason for withdrawal: Have you ever been convicted of a crime and or released from confinement following a conviction for any criminal offense? Arrests or charges that have been expunged need not be disclosed. Yes No If yes, give date, place and nature of each such conviction. _ Are you presently charged with any violation of the law? Yes No If yes give date, place and nature of each such charge. EMPLOYMENT: (Names and addresses of last three employers (including present) and dates of employment. Employers will not be contacted) Name Address Dates of Employment EDUCATION: List name and location of all schools attended, including high school. Name Address Degree Earned/# Hrs. Completed All transcripts must be submitted including high school transcripts.

5 REFERENCES PLEASE GIVE US THE NAMES, COMPLETE MAILING ADDRESSES AND ADDRESSES OF THREE (3) REFERENCES THAT ARE NOT RELATED TO YOU: (PLEASE PRINT CLEARLY) Name (Mr., Mrs., Miss) Address City, State, Zip Code Address Name (Mr., Mrs., Miss) Address City, State, Zip Code Address Name (Mr., Mrs., Miss) Address City, State, Zip Code Address Applicant s Name (PLEASE PRINTED CLEARLY) Phone # Applicant s Signature Date

6 TECHNICAL STANDARDS The following is a list of Technical Standards for all students enrolled in the Surgical Technology Program. These standards indicate the requirements necessary for a student to function as a student Surgical Technologist. A student must have the ability to perform all the requirements listed below: 1. Visual acuity with corrective lenses to read very fine, small print on medication containers, physician s orders, monitors, and equipment calibrations and small sutures. 2. Hearing ability with auditory aids to: understand the normal speaking voice without viewing the speaker s face, hear monitor alarms, emergency signals, take/hear blood pressure, understand muffled voices due to surgical mask and respond appropriately. 3. Physical ability to stand for prolonged periods of time, perform cardiopulmonary resuscitation, lift patient and objects of 50 lbs. or more, and move from room-to-room or maneuver in limited spaces. 4. Communicate effectively in verbal and written form by speaking clearly and succinctly when explaining treatment procedure, describing patient conditions, and implementing health teaching. Write legibly and correctly in patient s chart for legal documentation. 5. Manual dexterity to use sterile technique to insert catheter, pass surgical instruments appropriately, and set up using aseptic technique. 6. Function safely under stressful conditions with the ability to adapt to ever-changing environment inherent in clinical situations involving patient care. 7. Possess the intellectual ability and emotional stability to exercise independent judgment to properly care for the surgical patient and accurately utilize all resource material available to prepare for a surgical procedure. Accurately identify, calculate dosage, and transfer medications. Work calmly and efficiently in stressful situations and maintain calmness during emergency situations. Perform duties while exposed to communicable diseases, unpleasant sites, odors, and materials. 8. Environmental requirements and conditions for a Surgical Technologist involves risks and/or discomforts that require special safety precautions such as wearing gowns, caps, masks, gloves, and eye protection. Submit to periodic drug screening, and adhere to the policies of the externship facility attending. I have read and understand the Surgical Technology Technical Standards. By signing below, I verify that I have the ability to perform all these requirements. Signature Print Name Date

7 QUESTIONNAIRE Applicant s name: In a paragraph of not less than 50 words tell us your reason for wanting to enter into the Surgical Technology Program. Please write clearly and neatly. List any asset you have that you think would be beneficial to Surgical Technology.

8 SURGICAL TECHNOLOGY PROGRAM CHECKLIST It is the PROSPECTIVE STUDENT S RESPONSIBILITY to make sure we have all the relevant documents in your file. If we do not have these items on or before the last Thursday in May, the applicant will not be considered for the program. Application of Admission to the Surgical Technology Program Admission to WCJC; a copy of the WCJC application or of acceptance should also be included with your application if you are not currently enrolled at WCJC Questionnaire Three (3) References (names with complete mailing and addresses) Technical Standards Copy of High School transcript or GED Copy of College Transcript(s) from each college attended. NOTE: The Surgical Technology Department will not be responsible for securing transcripts from the WCJC Registrar s Office. Copy of ACT scores TSI (Texas Success Initiative) satisfied Copy of Driver s License Must be at least 18 years of age Hepatitis B series Series must be started prior to application deadline. (Documentation of at least one vaccine by the application deadline or provide a positive antibody (IgG) titer indicating proof of immunity). Attendance at Information Session prior to the application deadline. (date) All information turned in by the last Thursday in May It would be helpful if all information is in the order as listed on this checklist and submitted all at once to: Wharton County Junior College Surgical Technology Department ATTN: Barbara Lee 911 Boling Highway Wharton, TX IT IS THE SOLE RESPONSIBILITY OF THE APPLICANT TO MAKE SURE THAT ALL REQUIRED PAPERWORK IS SUBMITTED TO THE SURGICAL TECHNOLOGY PROGRAM BY THE LAST THURSDAY IN MAY. Wharton County Junior College is an equal opportunity institution. If does not discriminate against any person in its employment, personnel relations, admission or services because of the person s age, race, color, religion, sex, place of national origin, or handicap

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