CLINICAL RESEARCH ASSOCIATE / RESEARCH MONITOR

Transcription

1 INFORMATION PACKET Fr mre infrmatin, cntact Regina Pnder, Exec. J.D., C.C.R.P. Prgram Directr at CLINICAL RESEARCH ASSOCIATE / RESEARCH MONITOR Certificate f Cmpletin in Clinical Research Assciate

2 108 N. 40th Street Phenix, AZ (602) Clinical Research Assciate/Mnitr Prgram Dear Prspective Student: Thank yu fr yur interest in ur exciting Clinical Research Assciate/Mnitr Prgram. GWCC is prud t ffer a sixteen (16)-credit-hur Certificate f Cmpletin in the Clinical Research Assciate (CRA) Prgram. Five curses relating t cre ccupatinal cmpetencies are required t cmplete the prgram. Each fcuses n specific skills and knwledge required in the CRA field. CRAs, als knwn as Research Mnitrs, typically wrkk in the pharmaceutical, bitechnlgy, cntract research rganizatin and medical devicee industries. They are respnsible fr a brad range f functins, dependent upn the types f clinical research being dne and the type f emplyer r research spnsr. Clinical research integrates bimedical and health science knwledge with business practices, ffering unique pprtunities and team specializatins fr bth healthcare and business prfessinals. This prgram is taught in accrdance with standards f the Sciety f Clinical Research Assciates (SCRA) and the Assciatin f Clinical Research Prfessinals (ACRP), bth f which have natinally and internatinally recgnized certificatin exams. Please nte that the attached infrmatin is revised peridically. It is the applicant s respnsibility t check fr changes that may ccur. Thank yu again fr yur interest, Regina Pnder, Exec. J.D., C.C.R..P. Directr f Clinical Research Prgrams regina.pnder@gwmail.maricpa.edu A Maricpa Cmmunity Cllege learn mre. liv ve better.

3 TABLE OF CONTENTS Career Overview... 4 Prgram Infrmatin & Requirements... 4 Prgram Ntes... 4 Admissin Criteria... 4 Certificate Requirements Clinical Research Assciate... 5 Prgram Prerequisites... 5 Certificate f Cmpletin in the Clinical Research Assciate... 5 Estimated Prgram Csts... 6 Backgrund Check, Immunizatins, and Drug Testing Requirements... 7 Frequently Asked Questins... 8 Accreditatin... 9 Plicies, Rules, Requirements, and Regulatins Cmpliance... 9 Cllege Cmmunicatin... 9 Cntact Infrmatin Hw t Apply & Enrll in GateWay Cmmunity Cllege Student Services Admissin Applicatin Disclaimer MCCCD Summary f Criminal Backgrund Check Requirements MCCCD Acknwledgement f Criminal Backgrund Check Requirements Clinical Research Assciate Certificate Prgram - Applicatin fr Admissin Clinical Research Assciate 3 June

4 CAREER OVERVIEW Natinally and internatinally, the clinical research industry is expanding and needs highly trained persnnel. Clinical research fcuses n cures, treatments, and therapies and the steps necessary t bring new medical treatments and medical prducts t market. The primary functin f a CRA is t mnitr clinical trials. Typically, CRAs wrk directly with pharmaceutical, device r cntract research cmpanies t ensure that research is being perfrmed in cmpliance with the research prtcl, gd clinical practices (GCP) and regulatry standards. In particular, the CRA s jb may include extensive lcal r reginal travel t research sites t review research dcumentatin and t cmmunicate with site researchers and their staff. A CRA s jb may have varius levels f respnsibilities and titles. Examples include junir and senir CRAs, prject managers, mnitrs, and trial liaisns. The salary range is als highly variable depending n backgrund, experience and respnsibilities. Natinal Certificatin Tw rganizatins ffering prfessinal research certificatins include the Sciety f Clinical Research Assciates (SCRA) and the Assciatin f Clinical Research Prfessinals (ACRP). The GWCC CRA Certificate prepares eligible students t sit fr either rganizatin s certificatin exam. Eligibility includes field experience fr bth rganizatins; hwever, the GateWay CRA prgram meets the cllege credit requirements fr bth SCRA and ACRP. T learn mre abut the requirements fr either prfessinal certificatin, please visit the SCRA and ACRP PROGRAM INFORMATION & REQUIREMENTS The CRA Certificate Prgram fcuses n behaviral cmpetencies and technical skills fr CRAs including site mnitring, regulatry cmpliance, ethical issues, investigatinal agent accuntability, and adherence t Gd Clinical Practice Guidelines. Timeline The Certificate f Cmpletin is achievable within a mnth perid. PROGRAM NOTES Students must earn a grade f "C" r better fr all curses required within the prgram. + indicates curse has prerequisite and/r c-requisites ADMISSION CRITERIA Frmal applicatin and acceptance int the prgram is required as well as a permissin f the prgram directr based upn evaluatin f ccupatinal and educatin backgrund are required. Clinical research crdinatr with a Bachelr f Arts/Science, r higher degree OR Bachelr degree r higher degree in life r health sciences OR Bachelr f Arts degree with experience in healthcare r research experience Clinical Research Assciate 4 June

5 Registratin Check the registratin dates, prcedures and classes listed in the cllege class schedule. If yu need assistance with registratin, cntact a Health Science Academic Advisr in the Center fr Health Careers Educatin (CHCE) at r CERTIFICATE REQUIREMENTS CLINICAL RESEARCH ASSOCIATE PROGRAM PREREQUISITES Nne CERTIFICATE OF COMPLETION IN THE CLINICAL RESEARCH ASSOCIATE CRA290 Intrductin t the Clinical Research Assciate Rle 3.0 CRA291 Mnitring 4.0 CRA293 Clinical Study Develpment 3.0 CRA295 Ethics and Regulatins 3.0 CRA297 Clinical Trial Material and Device Accuntability 3.0 Clinical Research Assciate 5 June

6 ESTIMATED PROGRAM COSTS The estimated cst fr the prgram is utlined in the chart belw. Certificate f Cmpletin Tuitin* (16 credit $84 a credit hr) *... $ 1,344 Registratin fees ($15 per semester) Curse / Lab Fees Bks** Other Prgram Csts: Graduatin Fee Out-f-Cunty residents pay $359* / Out-f-State residents pay $325** a credit hr 1 Ttal Estimated Csts $ 1,794 * 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. Clinical Research Assciate 6 June

7 BACKGROUND CHECK, IMMUNIZATIONS, AND DRUG TESTING REQUIREMENTS IMMUNIZATION AND TB TESTING REQUIREMENTS Please review the health and safety packet available at The health and safety requirements are subject t change based n the requirements f ur clinical partners. The mst up t date infrmatin is lcated at the afrementined website. 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. Please review the plicy annuncement and FAQs n the MCCCD website 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 Physical Therapist Assisting 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 r undcumented prescriptin 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 are allwed t cntinue in the prgram, but may be limited t clinical agencies that d nt test fr nictine. Clinical Research Assciate 7 June

8 FREQUENTLY ASKED QUESTIONS 1. In additin t the Prgram entry requirements, what else d I need t enter the CRA Certificate f Cmpletin Prgram? A. All students MUST knw and be able t perfrm basic cmputer functins and have a wrking knwledge f basic cmputer applicatins such as ing with attachments, cutting, cpying, pasting, editing, internet searching, printing, saving files, left and right muse functins, and using Micrsft Wrd and PwerPint, Adbe Acrbat Reader, and text/ntepad applicatins. B. A persnal r business address and a persnal r business cmputer system with Windws 2000 r higher, internet access and , Micrsft Wrd, PwerPint, and Adbe Acrbat applicatins. The GWCC cllege cmputer center has cmputers available fr students, if needed. 2. When des the next first curse, CRA290, Intrductin t Clinical Research Assciate Rle,? CRA290 is held in the spring and fall, and is 8 weeks in length. It is taught in an nline frmat. 3. D I need t be natinally certified t be a clinical research prfessinal? N, but certificatin enhances credibility and salary expectatins, and is becming an internatinal industry standard. 4. D the CRA Certificate f Cmpletin prgram classes need t be taken cnsecutively? Students must take CRA290 immediately upn entering the CRA prgram. After cmpletin f CRA290, it is recmmended that students take the ther fur (4) in rder r cncurrently. 5. Is there a prcess t fllw t apply fr the CRA Certificate Prgram? Students must cmplete an nline applicatin prir t admittance t the prgram. 6. Is Financial Aid available? The Financial Aid Office ffers many different ptins, such as schlarships, grants, etc. fr eligible students. Cntact the Financial Aid Office at t inquire. 7. Where will the classes be lcated? All CRA classes are nline, in 6 t 8 week frmats. 8. D I need t have a cmputer and ? The Maricpa Cmmunity Clleges require every student t set up a standardized accunt. Fr instructin n setting up an accunt, access the GWCC web site - All students are required t have internet access, an accunt, and gd basic cmputer/ Windws skills. If a student des nt have a cmputer at hme r wrk, a free accunt may be btained thrugh the Cmputer Center n campus. Students wh are nt cmfrtable with cmmn cmputer navigatin and functins (e.g., ing, attachments, cpying, pasting, editing, saving, left and right muse key functins, saving dcuments, internet searching, making hyperlinks, using basic windws prgrams like MS Wrd and PwerPint) need t take a basic cmputer curse befre entering the Prgram. CRA instructrs will nt prvide students with technical tutring n basic cmputer use. Students need cmputer systems using Windws 2007 r higher with reliable Internet access (preferably high-speed), Micrsft Wrd and PwerPint, and Adbe Acrbat Reader. Clinical Research Assciate 8 June

9 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. 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. 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 Clinical Research Assciate 9 June

10 CONTACT INFORMATION If yu have questins regarding the enclsed prgram material, please cntact ne f the fllwing prgram cntacts: Regina Pnder, Exec. J.D., C.C.R.P., Prgram Directr / Phne: / regina.pnder@gwmail.maricpa.edu Carlyn Delgad, Health Sciences Academic Advisr / Phne: / carlyn.delgad@gwmail.maricpa.edu Lucy Granill, Health Sciences Academic Advisr / Phne: / luciella.granill@gatewaycc.edu Clinical Research Assciate 10 June

11 HOW TO APPLY & ENROLL IN GATEWAY COMMUNITY COLLEGE STEP 1: APPLY FOR ADMISSION GateWay is ne f 10 Maricpa Cmmunity Clleges. T enrll t any f the clleges, yu must first create a student accunt. Yu may dwnlad the Student Infrmatin Frm here, cmplete the frm and it t enrll@gatewaycc.edu r g t my.maricpa.edu t cmplete the prcess nline. Please fully cmplete the Student Infrmatin frm because leaving missing data r blanks may impact yur ability t find schlarships r ther financial aid surces thrugh ACADEMIC WORKS t help pay fr cllege. T create an accunt, g t the MEID Accunt Wizard, which is lcated within my.maricpa.edu. Fllw the instructins fr the MEID Accunt Wizard t create a user ID & passwrd. Keep this infrmatin t lgin t yur Student Center in the future. NOTE: Yu will need t wait 20 minutes after creating an accunt befre yu can apply. 1. G t yur Student Center n my.maricpa.edu 2. Enter yur MEID (User ID) & Passwrd 3. Once in yur Student Center, click n MCCCD Admissins and cntinue with steps t apply All admitted students will be issued an accunt that crrespnds with their MEID, accessible thrugh the Online Student Center. Yu are able t frward messages t yur persnal accunt, t. Please Nte: This accunt will be used t cmmunicate all fficial business messages frm the cllege, including: Class Enrllment Financial Aid Grades Payment Invices Tuitin Due Dates Other Imprtant Student Infrmatin The address fr this MEID wuld be: ABCDE12345@maricpa.edu Yur MEID shuld be a cmbinatin f apprximately 10 letters and numbers in length, such as: ABCDE12345 New t cllege? Learn abut ur istart Smart prgram and get a cmpetitive edge n starting a successful cllege career. Be sure t participate in an rientatin sessin befre beginning classes fr the first time n campus. Learn mre abut ur Prp 300 plicies. Help is available upn request Clinical Research Assciate 11 June

12 STEP 2: APPLY FOR FINANCIAL AID AND PAY Financial Aid Befre yu apply fr financial aid, yu will need t cmplete the Free Applicatin fr Federal Student Aid (FAFSA). Once yu submit this frm, yu can check the status f yur financial aid by ging t the Student Center and lgging in with yur MEID & passwrd. Additinal financial aid pprtunities, schlarships and grants may be available t yu. T learn mre, visit ur financial aid page r call (855) Please Nte: Yu will need t verify and cmply with all financial aid deadlines thrugh FAFSA r yur classes culd be drpped. Hw t Pay 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. The enrllment prcess is nt cmplete until yur payment is made in full. The fllwing infrmatin has been created t help yu find the methd f payment that's right fr yu. Online G t the Online Student Center and lgin t yur accunt using yur MEID & passwrd t pay by credit card, e-check r payment plan nline. By Phne Call (602) t make a credit card payment by phne. Please Nte: Wait times may increase during peak perids f enrllment. In Persn G t the Cashier's Office at Enrllment Services, lcated in the IE (Integrated Educatin Building) t pay fr classes in full, using cash r credit. Picture ID may be required fr sme student transactins. STEP 3: ASSESSMENT TESTING If yu are planning t enrll in an English, Math r Reading curse, yu may be required t take assessment tests at Enrllment Services Testing Center, lcated in the IE (Integrated Educatin) Building. Test scres are used t decide which curses t take. Here s what yu need t knw befre yu g: Assessment tests are free f charge. These tests are gd fr tw years. Separate tests fr English, Math and Reading may be required. Testing times vary depending upn the user's pace. On average, each test takes apprximately 25 minutes. Pht ID and Student ID number required. Bring a cpy f yur unfficial transcripts. Walk-in appintments are accepted with a Student ID. Students may als cntact a prgram advisr, faculty member r cunselr t make an appintment. Please review the Testing Center's page fr hurs and schedule. Clinical Research Assciate 12 June

13 STEP4: STEP 5: STEP 6: STEP 7: 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. MEET WITH A HEALTH SCIENCE ADVISOR We strngly encurage all new students t cntact a Health Sciences Academic Advisr. The missin f ur advisement team is t prvide services that enhance student develpment & success, including: Explratin f educatinal & life gals Selectin f academic/ccupatinal prgrams Selectin f sequencing f curses University transfer ptins General infrmatin n campus resurces & classes 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 frm 8 a.m. t 5 p.m. Fridays frm 8 a.m. t 1 p.m. (but clsed n Fridays in the Summer) Tuesdays-Wednesdays-Thursdays. Decrease yur waiting time by scheduling an appintment. 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: 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. PROGRAM APPLICATION Many f GateWay Cmmunity Cllege s Health Science prgrams have a special admissins prcedure. The Clinical Research Assciate Prgram infrmatin packet cntains detailed infrmatin regarding this prcess. Please be sure t review this infrmatin t ensure that yur applicatin material is cmplete. SELECT YOUR CLASSES & REGISTER GateWay requires n-time registratin because we believe success starts frm day ne. Enrll early, get yur bks and be in class ready t learn frm the first day. Fr classes with published start dates and meeting times, registratin in the class must be cmpleted befre the first fficial class meeting date and time. N late registratin in a class nce it has started is allwed. Registratin fr a class n the date it starts must be dne in persn r n the phne, and must be cmpleted befre the class start time. Clinical Research Assciate 13 June

14 Fr classes withut published meetings times, registratin in the class must be cmpleted by 11:59 p.m. the day befre the class starts. Yu will find there are many ways t receive academic, financial r career assistance t get invlved in ur cmmunity. The Maricpa Cmmunity Clleges Class Schedule allws yu t find classes by semester, time & date. Pick ut the classes yu want and g t the My.maricpa.edu Online Student Center. Lgin using yur MEID & passwrd t create yur class schedule. STUDENT SERVICES The fllwing are sme f the services available t students. Advising Meeting with a Health Sciences academic advisr in the Center fr Health Careers Educatin (CHCE) is n a walk-in basis n Mndays frm 8 a.m. t 5 p.m. and n Fridays frm 8 a.m. t 1 p.m. (but clsed n Fridays in the Summer). Fr an appintment n Tuesdays-Wednesdays-Thursdays, yu may call 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 Clinical Research Crdinating 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 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 Clinical Research Assciate 14 June

15 ADMISSION APPLICATION DISCLAIMER Yur admissin t the GateWay Cmmunity Cllege Clinical Research Assciate Prgram is n guarantee that yu will receive a Certificate f Cmpletin frm the Cllege. Cmpletin f the Clinical Research Assciate prgram is n guarantee yu will fr btain Natinal Certificatin. I have read and understand the Admissins Applicatin Disclaimer. Signature Date Student ID Number (which begins with the # 3) This Disclaimer will becme a part f yur permanent Prgram recrd. Clinical Research Assciate 15 June

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17 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 17

18 Summary f Criminal Backgrund Check Requirements.dcx 18

19 (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 19

20 Any inclusin n any f the Federal exclusin lists r Hmeland Security watch list Any cnvictin f Felny n matter what the age f the cnvictin Any warrant any state Any misdemeanr cnvictin fr the fllwing N matter age f crime - vilent crimes - burglary - sex crime f any kind including nn - pandering cnsensual sexual crimes and sexual - any crime against minrs, children, assault vulnerable adults including abuse, - murder, attempted murder neglect, explitatin - abductin - any abuse r neglect - assault - any fraud - rbbery - illegal drugs - arsn - aggravated DUI - extrtin Any misdemeanr cntrlled substance cnvictin last 7 years Any ther misdemeanr cnvictins within last 3 years Exceptins: Any misdemeanr traffic (DUI is nt cnsidered Traffic) I understand that I must disclse n all backgrund check data cllectin frms (DPS, MCCCD backgrund check vendr and a clinical agency backgrund check vendr) all required infrmatin including 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. That includes any misdemeanrs r felnies in Arizna, any ther State, r ther jurisdictin. I als understand that I must disclse any ther relevant infrmatin n the frms. I further understand that nn disclsure f relevant infrmatin n the frms that wuld have resulted in failing the backgrund check will result in denial f admissin t r remval frm a Prgram. Finally, I understand that my failure t disclse ther types f infrmatin f the frms will result in a vilatin f the Student Cde f Cnduct and may be subject t sanctins under that Cde. I understand that, if a clinical agency t which I have been assigned des nt accept me based n my criminal backgrund check it may result in my inability t cmplete the Prgram. I als understand that MCCCD may, within its discretin, disclse t a clinical agency that I have been rejected by anther clinical agency. I further understand that MCCCD has n bligatin t place me when the reasn fr lack f placement is my criminal backgrund check. Since clinical agency assignments are critical requirements fr cmpletin f the Prgram, I acknwledge that my inability t cmplete required clinical experience due t my criminal backgrund check will result in remval frm the Prgram. I understand the Prgrams reserve the authrity t determine my eligibility t be admitted t the Prgram r t cntinue in the Prgram and admissin requirements r backgrund check requirements can change withut ntice. I understand that I have a duty t immediately reprt t the Prgram Directr any arrests, cnvictins, placement n exclusin databases, suspensin, remval f my DPS Fingerprint Clearance Card r remval r discipline impsed n any prfessinal license r certificate at any time during my enrllment in a Prgram. Signature Date Printed Name Student ID Number Desired Health Care Prgram Summary f Criminal Backgrund Check Requirements.dcx 20

21 Clinical Research Certificate Prgram Applicatin fr Admissin MEMORANDUM TO: FROM: SUBJECT: Applicants t the Clinical Research Prgram at GateWay Cmmunity Cllege (GWCC) Prgram Directr Plicy and Prcedures fr Applying t the CR Certificate Prgram The Clinical Research Prgram at GWCC seeks students wh are well runded individuals with diverse backgrunds and strengths, strng writing ability, and critical thinking skills. Eligible students may submit an applicatin t the Prgram up thrugh ne week befre the start date f respective semester f enrllment. Admissin t the Clinical Research Prgram is cmpetitive. Students will be selected frm all applicants meeting the Minimum Requirements fr Admissin (as delineated belw, cmpleting Sectins 1 15). Currently the prgram ffers tw certificates: Clinical Research Crdinating and Clinical Research Assciate/Mnitring. This applicatin applies t the Clinical Research Assciate/Mnitr Certificate Prgram. Applicatin Deadline Applicatins are due n less than ne week (r five business days delivered r pstmarked) fr admissin int the Prgram in the desired semester. Applicatins t the Clinical Research Assciate Prgram will nt be prcessed if the student has nt been admitted t GWCC. Admissin t GWCC is a separate applicatin prcess thrugh the GWCC Office f Admissins. Minimum Requirements fr Admissin 1) Admissin t GWCC by the applicatin deadline; 2) Physical, mental, and emtinal health that enables a student t actively participate in and successfully cmplete an nline curriculum prgram. 3) Strng writing skills and critical thinking skills as demnstrated in the required essay. 4) Cmpleted applicatin, delivered r pst marked within ne week f the desired semester start date, including a signed and dated resume and essay. 5) Willingness t participate in an initial interview with the prgram directr; Students residing in the Greater Metrplitan Phenix area are encuraged t meet with directr in a face t face interview. Out f state applicants can participate via a telecnference. 6) All students whether r nt lcal will be asked t participate in a backgrund check. Please see Admissins Requirements, Sectin 13. 7) Sme f yu may g n t participate in sme frm f an arranged internship. GWCC as well as Participating institutins will als have a set f criteria that must be met. Yu must be willing t meet the minimum requirements fr participatin, including health and safety requirements (immunizatins), ptential fr a variable schedule, and backgrund checks passing the supplemental backgrund check and a level 1 fingerprint clearance card. Evaluating Curses frm ther Institutins Successful cmpletin f prerequisites cannt nt be evaluated withut prper dcumentatin: 1. Official transcripts must be submitted t the Registrar fr cnsideratin prir t applying t the Prgram. 2. At the time f applicatin, students must als submit t the Clinical Research Prgram, cpies f transcripts fr all cllege curses taken utside f GWCC which are nt reflected in the GWCC certificate audit. 3. Students taking curses at ther institutins at the time f applicatin must have fficial transcripts f final grades sent t the GWCC Admissins Office and the Clinical Research Prgram immediately upn cmpletin f the curses. Admissin Decisins Admissin decisins may be cmmunicated t students via US mail (sent t mailing address indicated n the applicatin) r electrnic mail. Acceptance cmmunicatin shuld be saved by students fr future recrds. Cntact Infrmatin Questins abut the applicatin prcess may be directed t Student Advisement, Carlyn Delgad Delgad@gatewaycc.edu r any ther designated clinical research prgram student advisr. Please submit applicatin and all requested dcumentatin nline as an attachment t pnder@gatewaycc.edu r feel free t mail it t: GateWay Cmmunity Cllege and supprting infrmatin t Dr. Regina Pnder, at the address prvided n the Applicatin. GWCC Clinical Research Crdinating Prgram (v ) 21 P age

22 Applicatin fr Admissin Clinical Research Assciate/Mnitr Applicant Infrmatin Full Name: Address: Last First M.I. Street Address Apartment/Unit # City State ZIP Cde Hme Phne: ( ) GWCC ID Number Cell Phne: ( ) Address Mailing Address: Street Address Apartment/Unit # City State ZIP Cde Demgraphic and Backgrund Infrmatin Race and Ethnicity infrmatin is being requested in accrdance with federal regulatins. The infrmatin is vluntary and will nt be used when cnsidering yu fr admissin t the Clinical Research Prgram. 1. Racial r Ethnic Grup American Indian/Alaskan Asian/Pacific Islander Black/African American Hispanic/Latin White/Caucasian Other 2. Gender Female Male 3. Date f Birth / / Mnth / Day / Year 4. Are yu a US citizen? Yes N 5. If yu are nt a US citizen, what is yur native cuntry? 6. Is English yur native language? Yes N 7. If English is nt yur native language, have yu taken the TOEFL (Test f English as a Freign Language)? Yes N 8. Have yu ever been cited fr r cnvicted f any crime r misdemeanr ther than a traffic vilatin? N 9. Are yu currently emplyed? N Yes, specify: Yes, if yes, hw many hurs per week? 10. Hw did yu hear abut the CRC Prgram (check all that apply). Please prvide name f cntact referral: Cllege Student Advisr CRC Brchure Fellw Student Online Search Clinical Research Website Faculty Member C Wrker Other, r Cntact Referral specify: GWCC Clinical Research Crdinating Prgram (v ) 22 P age

23 Academic and Prfessinal Infrmatin Race and Ethnicity infrmatin is being requested in accrdance with federal regulatins. The infrmatin is vluntary and will nt be used when cnsidering yu fr admissin t the Clinical Research Prgram. 11. Besides GWCC, what universities r clleges have yu attended? Institutin and Lcatin Dates Attended Degree(s) Awarded Resume 12. Please submit yur signed and dated resume with this applicatin. (Nte: The GWCC Career Center ffers assistance with resumes, if needed). Admissins Requirements 13. Prerequisites. Please reference the current CRA Infrmatin Packet. Please als reference aid fr infrmatin n student financial aid. Backgrund checks are required fr all clinical research nline students. Please cnsult the prgram directr fr clarificatin and any questins. Review the plicy annuncement and FAQs n the MCCCCD website at Only the backgrund check and fingerprint clearance is required fr the nline student participatin. Incmplete Admissins Requirements 14. Plans fr cmpleting utstanding deficient prgram requirements. List utstanding prgram requisites and yur plans fr cmpleting them. Curse name and number Semester/Year Cllege r University Cntinue t Required Essay Sectin 15, next page. GWCC Clinical Research Crdinating Prgram (v ) 23 P age

24 Required Essay 15. We want yur participatin in this prgram t be a rewarding experience yu. Please share why are yu interested in a btaining a certificate in clinical research assciate/mnitring and what it is yu hpe t achieve frm yur endeavr with this plan f study? (One page limit, duble spaced, 12 pitch fnt). GWCC Clinical Research Crdinating Prgram (v ) 24 P age

25 Signature - Required f all Applicants I certify that the infrmatin n this applicatin is cmplete and crrect. I understand that withhlding infrmatin requested r giving false infrmatin will make me ineligible fr prgram admissin and enrllment t the Clinical Research Prgram. I authrize the Clinical Research Prgram Admissins Cmmittee t make reasnable inquiries int the accuracy f the infrmatin prvided. In additin, I understand that the Clinical Research Assciate Prgram is an nline curse f study and admissin t this prgram will subject me t the laws and regulatins gverning distance learning prgrams f study receiving Federal financial aid. Signature f Applicant Date GWCC Statement GateWay Cmmunity Cllege is cmmitted t and will prvide equality f educatinal and emplyment pprtunity fr all persns regardless f race, sex, age, clr, gender, natinal rigin, ethnicity, creed, religin, disability, sexual rientatin, plitical affiliatin, marital status, veteran status r relatinship t ther university cnstituents except where sex, age r ability represent bna fide educatinal r ccupatinal qualificatins r where marital status is a statutrily established eligibility criterin fr state funded emplyee benefit prgrams. Cntact Infrmatin Deliver r Mail Applicatins t: Regina Pnder, Exec. JD, CCRP Clinical Research Prgram Directr GateWay Cmmunity Cllege Health Sciences Divisin 108 N. 40th Street Phenix, AZ Applicatin Deadline All applicatins fr the Clinical Research Assciate/Mnitring Prgram (fr bth currently enrlled students and transfer students) must be delivered t the Prgram ffice r pstmarked n later than ne week prir t desired semester start. End f Applicatin Thank yu fr yur interest in the Clinical Research Assciate/Mnitring Prgram at GateWay Cmmunity Cllege! GWCC Clinical Research Crdinating Prgram (v ) 25 P age