INFORMATION/APPLICATION PACKET 2015 2016 Fr mre infrmatin, cntact Regina Pnder, Exec. J.D., C.C.R.P. Prgram Directr at 602.286.8488 CLINICAL RESEARCH COORDINATOR Certificate f Cmpletin in Clinical Research Crdinatr Link t nline packet: Clinical Research Crdinatr Prgram Packet
108 N. 40th Street Phenix, AZ 85034 (602) 286-8000 www.gatewaycc.edu Clinical Research Crdinating Prgram Dear Prspective Student: Thank yu fr yur interest in ur exciting Clinical Research Crdinating Prgram. GWCC is prud t ffer the first cmmunity cllege-based Clinical Research Crdinatr prgram west f the Mississippi. GWCC ffers a 29 credit hur CRC Certificate f Cmpletin prgram. Clinical Research Crdinatr graduates are emplyed in varius clinical research settings where they are respnsible fr a brad range f functins, dependent upn the types f clinical research being dne and the clinical settings. Clinical research integrates bimedical and healthh 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 natinal and internatinally recgnized certificatin exams. After ne year f direct CRCC experience, crdinatrs are eligible t take the SCRA natinal certificatin exam and after tw years f wrk experience may take the ACRP certificatin exam. 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 602.286.8488 pnder@gatewaycc.edu A Maricpa Cmmunity Cllege learn mre. liv ve better.
TABLE OF CONTENTS Career Overview... 4 Prgram Infrmatin & Requirements... 4 Certificate Requirements Clinical Research Crdinating... 6 Admissin Criteria... 6 Prgram Prerequisites... 6 Certificate f Cmpletin Clinical Research Crdinating... 6 Estimated Prgram Csts... 7 Backgrund Check, Immunizatins, and Drug Testing Requirements... 8 Frequently Asked Questins... 8 Cllege Cmmunicatin... 9 Accreditatin... 10 Cnfidentiality Statement... 10 Plicies, Rules, Requirements, and Regulatins Cmpliance... 10 Cntact Infrmatin... 11 Hw t Apply & Enrll in GateWay Cmmunity Cllege... 11 Student Services... 15 Admissin Applicatin Disclaimer... 17 MCCCD Summary f Criminal Backgrund Check Requirements... 19 MCCCD Acknwledgement f Criminal Backgrund Check Requirements... 21 Applicatin fr Admissin Clinical Research Crdinatr Prgram... 23 Clinical Research Crdinatr 3 September 2015-1
CAREER OVERVIEW Natinally and internatinally, the clinical research industry is expanding and needs highly trained persnnel. Plan, direct, r crdinate clinical research prjects. Direct the activities f wrkers engaged in clinical research prjects t ensure cmpliance with prtcls and verall clinical bjectives. May evaluate and analyze clinical data. * Clinical Research Crdinatrs (CRCs) are specialists wh manage, and implement human subject clinical trials in a variety f health care settings. CRCs require a brad knwledge and skill set that includes an understanding f healthcare systems, general and medical ffice practices, patient assessment, prject management, research ethics, clinical trial study design and management, and quality assurance and prcess efficiency practices. A clinical trial invlving human subjects is generally managed by clinical research crdinatrs under the directin f a Principal Investigatr (typically a physician). Clinical Research Crdinatrs cme frm diverse backgrunds. CRCs may be nurses, allied health prfessins, r have medical ffice backgrunds, as well as be business prfessinals transitining int the clinical research arena. Sample f reprted jb titles: Clinical Research Crdinatr, Clinical Trial Manager, Clinical Prgram Manager, Clinical Research Nurse Crdinatr, Clinical Prgram Crdinatr, Clinical Research Administratr, Clinical Research Manager, Clinical Trial Crdinatr, Research Crdinatr. * 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 CRC Certificate prepares eligible students t sit fr either rganizatin s certificatin exam. Eligibility includes field experience fr bth rganizatins; hwever, the GateWay CRC prgram meets the cllege credit requirements fr SCRA. T learn mre abut the requirements fr either prfessinal certificatin, please visit the SCRA, ACRP web sites. * Fr infrmatin abut careers in Clinical Research Crdinatrs, visit O*NET OnLine @ http://www.netnline.rg/link/summary/11-9121.01 fr detailed jb descriptins, educatin requirements, wage and emplyment trend infrmatin. PROGRAM INFORMATION & REQUIREMENTS The Certificate Prgram fcuses n behaviral cmpetencies and technical skills fr CRCs including research site preparatins, subject screening, enrllment, recruitment, fllw up visits, maintenance and dispensing f investigatinal prduct supplies, cmpletin f case reprt frms and regulatry dcuments, and adherence t Gd Clinical Practice Guidelines. Descriptin: The Certificate f Cmpletin (CCL) in Clinical Research Crdinating prgram is achievable within a 12-24 mnth perid. Required cursewrk cvers site management, prject activities, subject crdinatin, and regulatry dcumentatin and administratin. The prgram fcus is n the achievement f behaviral cmpetencies and technical skills fr Clinical Research Crdinatrs (CRC) including research site preparatin; subject screening, enrllment, recruitment, and fllw-up visits; maintenance and dispensing f drug supplies; cmpletin f case reprt frms and regulatry dcuments; and the adherence t Gd Clinical Practice guidelines. The Clinical Research Crdinating prgram is taught in accrdance with standards f the Sciety f Clinical Research Assciates (SCRA) and the Assciatin f Clinical Research Prfessinals (ACRP) fr their natinally and internatinally recgnized CRC certificatin examinatins. Curse cmpnents Clinical Research Crdinatr 4 September 2015-1
such as research ethics and Institutinal Review Bard peratins, are based n the standards and guidelines f the Public Respnsibility in Medicine and Research (PRIM&R). Independent Study Requirements It is recmmended that Arizna resident students shw evidence f having a current health care prvider CPR card befre cmpleting the prgram. Prvider level CPR curses are available at GWCC as well as many ther lcatins including the American Heart Assciatin, hspitals, cmmunity health centers, etc. An Independent Study curse is ffered fr students wh wuld like experience in the research industry befre pursuing a psitin in the field. These pprtunities are limited and may nt be available every semester. Additinally, they may nt be ffered in a hspital envirnment. The independent study curse requires that the student meet with the prgram directr, define his/her gals, assist in a search fr apprpriate pprtunities, and meet the requirements at the site. Clinical Research Crdinatr 5 September 2015-1
Registratin Check the registratin dates, prcedures and classes listed in the cllege class schedule. If yu need assistance with registratin, cntact a Prgram Advisr at the Center fr Health Careers Educatin (CHCE) at 602.286.8183 r 602.286.8189. CERTIFICATE REQUIREMENTS CLINICAL RESEARCH COORDINATING ADMISSION CRITERIA Frmal applicatin and acceptance int the prgram is required; In additin, the permissin f the prgram directr is required, which is based upn evaluatin f ccupatinal and educatinal backgrund. (resume/curriculum vitae* send t Dr. Pnder at pnder@gatewaycc.edu) PROGRAM PREREQUISITES - NONE CERTIFICATE OF COMPLETION CLINICAL RESEARCH COORDINATING Curse N. Curse Title Credits: 29 + ENG 101 First-Year Cmpsitin (3) OR + ENG 107 First-Year Cmpsitin fr ESL (3) 3 + CRC120 Intrductin t Clinical Research 4 + CRC200 Legal and Regulatry Research Cmpliance 4 + CRC210 Research Design and Data Management 4 + CRC225 Clinical Research Site Budget Prcess 2 + CRC240 Research Ethics 3 + CRC250 Clinical Research Site Management 4 + CRC255 Intrductin t Medical Devices in Clinical Evaluatin 2 + CRC270 Institutinal Review Bard in Clinical Research 3 + Indicates curse has prerequisite * Resumes must be signed and dated. Clinical Research Crdinatr 6 September 2015-1
ESTIMATED PROGRAM COSTS The estimated cst fr the prgram is utlined in the chart belw. Certificate f Cmpletin Tuitin* (29 credit hrs @ $84 a credit hr) 1... $ 2,436 Registratin fees ($15 per semester)... 45 Curse / Lab Fees... 145 Bks 2... 858 Other Prgram Csts... 82 Ttal Estimated Csts $ 3,566 Out-f-Cunty residents pay $359* / Out-f-State residents pay $325** a credit hr 1 * Rates are set accrding t Arizna Revised Statute. Applies nly t cunties with n cmmunity clleges. ** Accrding t Arizna Revised Statute, 15-1802 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 www.gatewaycc.edu 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 Crdinatr 7 September 2015-1
BACKGROUND CHECK, IMMUNIZATIONS, AND DRUG TESTING REQUIREMENTS IMMUNIZATION AND TB TESTING REQUIREMENTS Please review the health and safety packet available at http://www.gatewaycc.edu/sites/default/files/imce/images/infpacket_alliedhealthprgrams.pdf 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 https://asa.maricpa.edu/departments/healthcare-educatin-at-the-maricpa-cmmunity/maricpacmmunity-clleges-dental-hygiene/healthcare-educatin-ther-student-infrmatin. 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. FREQUENTLY ASKED QUESTIONS 1. What d I need t enter the CRC Certificate f Cmpletin prgram? A. Cmplete and submit applicatin alng with yur resume t the Prgram Directr, Dr. Regina Pnder. B. All students MUST knw and be able t perfrm basic cmputer functins and have a wrking knwledge f basic cmputer applicatins such as: emailing with attachments, cut, cpy, paste, edit, internet searching, printing, saving files, left and right muse functins, and be able t use Micrsft Wrd, PwerPint, and Adbe Acrbat Reader, and text/ntepad applicatins. C. A Maricpa student email address, a persnal email address and a persnal r business cmputer system with Windws 2000 r higher, internet access and email, Micrsft Wrd, Clinical Research Crdinatr 8 September 2015-1
PwerPint, and Adbe Acrbat applicatins. The GWCC cllege cmputer center has cmputers available fr students, if needed. 2. Hw ften is CRC 120 Intrductin t Clinical Research ffered? CRC120 is ffered every semester and nce during the summer r (3) three times per year in nline. (Fr the mst part students are nt required t be n the cmputer at any specific time t cmplete curse assignments mst assignments and tests are deadline driven. Prescheduled webinars may nly be ffered at designated times hwever.) 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 CRC Certificate f Cmpletin prgram classes need t be taken cnsecutively? Students must be accepted int the prgram prir t taking CRC120. Curses are t be taken sequentially r with permissin f the prgram directr apprval. After cmpletin f CRC120, students may duble up n curses, with the permissin f the CRC prgram directr. 5. Is there a prcess t apply fr the CRC Certificate? Students must cmplete an nline prir t prgram participatin. Directins fr cmpletin f the applicatin can be accessed via the Admissins and Recrds. 6. Is Financial Aid available? Financial Aid Office has many different ptins, schlarships, grants, etc. fr eligible students. Cntact the Financial Aid Office at 602.286.8300 t inquire. 7. Where will the classes be lcated? All CRC Certificate classes are held in an nline, 6-8-week frmat. Directins fr lgin, etc. will be distributed prir t class start dates. 8. D I need t have a cmputer and email? Yes. All students are required t have Internet access, a Maricpa email accunt (free t all GateWay students), and gd basic cmputer / Windws skills. If a student des nt have a cmputer at hme r wrk, the cmputer labratry n campus is available t students. Students wh are nt cmfrtable with cmmn cmputer navigatin and functins (e.g., emailing, attachments, cpy, paste, edit, saving, left and right muse key functins, saving dcuments, internet searching, making hyperlinks, using basic windws prgrams like MS Wrd, Pwer Pint) need t take a basic cmputer curse befre entrance int the prgram. CRC instructrs will nt prvide students with technical tutring n basic cmputer use. Needed cmputer applicatins include; Micrsft Wrd and PwerPint, Adbe Acrbat Reader and a cmputer system using Windws 2000 r higher with reliable Internet access, preferably high-speed. COLLEGE COMMUNICATION The fllwing infrmatin is very imprtant s yu d nt miss any ntices: We cmmunicate with students thrugh the Maricpa Cllege email; persn email accunts may be referenced frm time t time depending upn the respective instructr. We have a district-wide Ggle pwered email 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 e-mail regularly r frward the new student e-mail t a persnal e-mail t ensure that all fficial cllege cmmunicatin is received. Clinical Research Crdinatr 9 September 2015-1
Students may access their new e-mail 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 email 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 1-888-994-4433. 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 60602-2504, 800.621.7440), 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. CONFIDENTIALITY STATEMENT Students enrlled in prgram pathways f the HCIES will have learning experiences in health care settings where they will have access t cnfidential infrmatin. Prir t beginning any clinical studies, the students will be asked t sign agreements t adhere t the requirements f thse clinical sites and applicable law, including the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). 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 41-1758.03 (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. Clinical Research Crdinatr 10 September 2015-1
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: 602.286.8488 / E-mail: pnder@gatewaycc.edu Carlyn Delgad, Health Sciences Academic Advisr / Phne: 602.286.8183 / Email: delgad@gatewaycc.edu Lucy Granill, Health Sciences Academic Advisr / Phne: 602.286.8185 / Email: luciella.granill@gatewaycc.edu HOW TO APPLY & ENROLL IN GATEWAY COMMUNITY COLLEGE STEP 1: APPLY FOR COLLEGE 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 email 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 AcademicWrks 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 email accunt that crrespnds with their MEID, accessible thrugh the Online Student Center. Yu are able t frward messages t yur persnal email 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 e-mail 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. Clinical Research Crdinatr 11 September 2015-1
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 STEP 2: STEP 3: 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) 622-2332. 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) 286-8100 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. ASSESSMENT TESTING If yu are planning t enrll in an English, Math r Reading curse, yu may be required t take Placement Tests at Enrllment Services Testing Center, http://www.gatewaycc.edu/testing, 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. Clinical Research Crdinatr 12 September 2015-1
Please review the Testing Center s web page fr hurs and schedule. STEP 4: STEP 5: 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 All new students must cntact a Health Sciences Academic Advisr befre yur classes begin. It is the missin f ur advisement team 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, email, r in persn at the CHCE Center fr Health Careers Educatin Building, n the nrth side f campus during the fllwing business hurs: Walk-in basis Fr an appintment call 602.286.8600 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 Arrange t have yur fficial transcripts (frm all clleges & schls previusly attended) sent t: GateWay Cmmunity Cllege Attn: Admissins & Recrds 108 N 40th Street Phenix, AZ 85034 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. STEP 6: PROGRAM APPLICATION Many f GateWay Cmmunity Cllege s Health Science prgrams have a special admissins prcedure. The Clinical Research Crdinatr Prgram infrmatin packet cntains detailed infrmatin regarding this prcess. Please be sure t review this infrmatin t ensure that yur applicatin material is cmplete. Clinical Research Crdinatr 13 September 2015-1
STEP 7: STEP 8: 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. 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. ATTEND NEW STUDENT ORIENTATION (REQUIRED FOR ALL FIRST-TIME STUDENTS) Orientatins are held prir t Fall and Spring semesters and all students are welcme. Attendance t New Student Orientatins are REQUIRED fr all first-time t cllege students. Register Nw. Clinical Research Crdinatr 14 September 2015-1
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 602.286.8600. Bkstre Available are textbks and supplies fr classes, call 602.286.8400. Yu may visit their website at: www.efllett.cm and selecting Cllege Textbks. Canvas 24x 7 Supprts Line @ 1.888.994.4433 Cunseling Academic, persnal, r career cunseling available. Call 602.286.8900. Emplyment Upn cmpletin f the Clinical Research Crdinating Prgram, cntact the Career & Re-Entry Services, at 602.286.8500 fr assistance. Financial Aid Available fr qualified students Cntact the Financial Aid Office at 602.286.8300 r visit website: http://enrll.gatewaycc.edu/financialaid/applyfrfinancialaid/default.htm 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 602.286.8160 fr specific days and times tests are available. Tutring Assistance Available thugh the Learning Center, 602.286.8800. Fr a cmplete listing f student services, please refer t the cllege catalg, r visit GateWay s website: www.gatewaycc.edu r call cllege infrmatin at 602.286.8000. Clinical Research Crdinatr 15 September 2015-1
Clinical Research Crdinatr 16 September 2015-1
ADMISSION APPLICATION DISCLAIMER Yur admissin t the GateWay Cmmunity Cllege Clinical Research Crdinatr Prgram is n guarantee that yu will receive a Certificate f Cmpletin frm the Cllege. Cmpletin f the Clinical Research Crdinatr prgram is n guaranteeing 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 Crdinatr 17 September 2015-1
Clinical Research Crdinatr 18 September 2015-1
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 19
Summary f Criminal Backgrund Check Requirements.dcx 20
(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 21
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 22
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 Crdinating 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 email 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.01.08.15) 23 P age
Applicatin fr Admissin Clinical Research Crdinating Certificate Prgram Applicant Infrmatin Full Name: Address: Last First M.I. Street Address Apartment/Unit # City State ZIP Cde Hme Phne: ( ) GWCC ID Number Cell Phne: ( ) Email 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.01.08.15) 24 P age
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 CRC Infrmatin Packet. Please reference http://www.gatewaycc.edu/financial 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. Please als review the plicy annuncement and FAQs n the MCCCCD website at http://www.healthcare.maricpa.edu/. 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.01.08.15) 25 P age
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 crdinating 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.01.08.15) 26 P age
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 85034 Applicatin Deadline All applicatins fr the Clinical Research Crdinating 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 Crdinating Prgram at GateWay Cmmunity Cllege! GWCC Clinical Research Crdinating Prgram (v.01.08.15) 27 P age