Surg Tech App 2011-2012

CENTRAL TECHNOLOGY CENTER

SURGICAL TECHNOLOGY

APPLICATION PACKET

Read admission procedures for application process. Admission procedures, eligibility, cost

requirements are subject to change annually.

Central Technology Center

3 CT Circle

Drumright, OK 74030

918-352-2551

www.centraltech.edu

http://www.centraltech.edu/

Dear Applicant:

Thank you very much for your interest in Central Technology Center’s Surgical Technology

program. We are pleased that you are considering education in the field of Surgical Technology as

there is a great need in the state of Oklahoma for healthcare providers at all levels.

At Central Technology Center, we have a sincere interest in our students as individuals and in their

successful completion of Surgical Technology. We have a strong Surgical Technology program

which provides quality instruction both in theory (class lectures and presentations) and skills

(clinical practice). We utilize a wide variety of clinical sites to provide our students with excellent

hands-on surgical experiences.

We wish you success in your application process!

Sincerely,

Todd Prough

Surgical Technology Instructor

TUITION COSTS, FEES AND FINANCIAL ASSISTANCE

2011-2012

(Cost Subject to Change)

TUITION COSTS:

STUDENTS MUST HAVE FINANCIAL ARRANGEMENTS MADE PRIOR TO THE FIRST

DAY OF CLASS. NO ONE WILL BE ALLOWED TO PICK UP BOOKS, UNIFORMS OR

SUPPLIES WITHOUT A RECEIPT OR CLEARANCE FROM THE FINANCIAL AID

OFFICE.

Career Pathway Career Majors/Certifications

Hrs Sequence of Courses

Therapeutic Services

Surgical Technology 1200 clock hours COST: $4,344.00 (In‐District) COST: $6,144.00 (Out‐of‐District)

42 ORIENTATION TO SURGICAL TECHNOLOGY

30 INTRODUCTION TO SURGICAL TECHNOLOGY

20 BASIC SCIENCES FOR SURGICAL TECHNOLOGY I

52 BASIC SCIENCES FOR SURGICAL TECHNOLOGY II

78 BASIC SCIENCES FOR SURGICAL TECHNOLOGY III

87 ASEPTIC TECHNIQUE & SKILLS

50 SURGICAL PATIENT CARE & SKILLS

137 SUPPLIES/EQUIPMENT & SKILLS

24 SURGICAL TECHNOLOGY CLINICAL PRACTICUM I

16 SURGICAL PHARMACOLOGY

61 SURGICAL PROCEDURES I

66 SURGICAL PROCEDURES II

201 SURGICAL TECHNOLOGY CLINICAL PRACTICUM II

336 SURGICAL TECHNOLOGY CLINICAL PRACTICUM III

TUITION: $1800.00 (In‐District)

$3600.00 (Out‐of‐District) FEES: $889.00 BOOKS & SUPPLIES: $1655.00


SURGICAL TECHNOLOGY

INFORMATION SHEET

1. Surgical Technology provides the student with the knowledge and skills needed to function as a

member of the surgical team assuming appropriate responsibilities before, during and after

surgery. Instruction is provided in principles of aseptic techniques, patient care, basic sciences,

supplies and equipment of professional preparation. Salary range for this area is $13.00 -

$15.00/hour based on employment of 2010 graduates.

2. Surgical Technology is a full-time program that meets Monday through Friday.

Class hours are usually from 8:25 a.m. to 3:35 p.m. and clinical hours are usually 6:00 a.m. to 2:30

p.m. These times will vary according to the clinical facility being used; therefore, the student

MUST plan for some flexibility of the schedule.

3. A student must be present at least 94 percent of the scheduled time. Absences are not qualified as

excused or unexcused. Personal and business appointments should be made so as not to conflict

with classroom or clinical schedules.

4. Students are responsible for their own transportation to Central Tech and to the clinical sites.

Therefore, it is imperative you have reliable transportation.

5. It is essential that students be well prepared for each classroom and clinical experience. Therefore,

you must plan for adequate study time at home on average 3 to 4 hours per night.

6. All applicants tentatively accepted into the Surgical Technology will be required to submit to a

drug screening and OSBI background check at the applicant’s expense. A tentatively accepted

applicant must test negative to the drug test and pass the OSBI background check, to be allowed

entrance into the program.

7. Assessment Testing: All applicants must take the Test of Adult Basic Education before the

application is considered complete. The cost for the TABE assessment testing is $35.00 and must

be paid prior to scheduling of the assessment date. You may pay the fee in person to the Registrar

at the Drumright campus, or you may mail your check to Central Tech, attention Student Services,

Kristin Beitz. Please note on your check that this is for the Surgical Technology assessment.

8. Interview: Professional dress is required for the interview.

9. Financial Arrangements: Please contact Charlotte Gaunt, Bursar, at 918-352-2551, ext. 267, to

discuss financial arrangements prior to your interview.


SURGICAL TECHNOLOGY

STEP-BY-STEP APPLICATION PROCESS Step 1 Read the APPLICATION packet thoroughly. If you have questions, please call the Career Advisor at 918-352-2551,

ext. 208

Step 2 ASSESSMENT TESTS – Take the TABE and the CAPS & COPS Assessments.

International applicants must also provide proof of a passing TOEFL score or meet requirements for exemption. Refer to

“International Applicants Only”.

Step 3 REQUIRED DOCUMENTATION – submit the following required documents to the Career Advisor:

Central Technology Center Surgical Technology Admission Application Form

Official high school transcript or GED scores

Official copies of college transcripts from all colleges attended

Transcripts generated by schools outside the United States must be evaluated by a credentialing agency in order to

validate equivalency. (Contact the World Education Services at www.wes.org or check with local colleges and

universities.)

TABE Test & CAPS & COPS Indicator Assessment Test results

International Applicants – TOEFL scores (unless applicant meets exemption requirements)

Three (3) work references from supervisors, verifying job experience, or former instructors. These work references

must be from former or current supervisors, NOT co-workers or colleagues. Work references must be from

supervisors or teachers within the last 5 years. Work reference must be submitted on the Central Tech applicant

work reference forms provided. Hand written or typed letters will not be accepted.

Central Tech reserves the right to contact former employers for additional information regarding the applicant.

Step 4

Schedule Interview

(Please wear professional dress)

Step 5 NOTIFICATION OF ACCEPTANCE INTO PROGRAM & START DATE

Step 6

TUITION PAYMENT – Payment arrangements must be made with the Bursar prior to the first day of class. Contact Bursar for

Drumright campus at 352-2551, ext 267.

Step 7

STUDENT ORIENTATION - Student will be notified of the date and time of student orientation.

International Applicants Only A High School Equivalency Assessment letter indicating a foreign country education that is equivalent to a United

States high school education is required as proof of high school equivalency. The evaluation and letter are available

through the International Students Office at many colleges and universities. It can also be obtained from World

Education Services at www.wes.org.

The TOEFL (Test of English as a Foreign Language) exam is required for admission of international

students from non-exempt countries. Exempt countries for the TOEFL include Australia, Bahamas, British

Isles, Canada, Guyana, Jamaica, Liberia, New Zealand, South Africa, and the West Indies.

o A score >500 must be achieved on the paper-based exam to be considered for admission. In lieu of

this requirement, the applicant may instead:

o Achieve a score > 173 on the computer-based TOEFL

o Achieve a score > 61 on the Internet-based TOEFL

Provide proof of completion of 24 credit hours of college courses, taken in the United States, with a grade

of “C” or higher in all courses

Provide proof of graduation from a high school located in the United States

Note: Institutional TOEFL scores are acceptable.

Central Technology Center does not administer the TOEFL examination. The applicant may register for the examination online or over the phone. http://www.ets.org (Select “TOEFL”

from the list of exams) 1-800-GO-TOEFL (1-800-468-6335)

If the applicant has completed the “Institutional TOEFL” at a college or university, this score is acceptable and

meets the testing requirement.

Other applicants wishing to be exempt from the TOEFL exam must make an appointment with the Career Advisor

and present the reason for requesting an exemption. The Career Advisor’s determination of the need to take the

TOEFL is final.

Application and Selection Process Applications and all supporting documents are to be submitted to the Career Advisor. It is the applicant’s

responsibility to verify the completeness of the application file with the Career Advisor. Only completed files with

all documents, transcripts, and test scores verifying eligibility requirements will be accepted. If not selected and

wish to be considered for the next class, you must re-apply.

Non-Academic Admission Requirement

Criteria taken into account when admitting first-time or transfer students:

Whether the applicant has been expelled, suspended or denied admission by any educational institution.

Whether the applicant has been dismissed from employment by any hospital, nursing home, doctor’s office

or other healthcare facility.

Resignation in lieu of termination.

Criteria taken into account when readmitting withdrawn students:

Reason for withdrawal

Faculty recommendation

In good academic standing and financial standing with Central Tech

Actions taken to correct deficiencies

Class Start Dates

School year begins August 18, 2011.

CENTRAL TECHNOLOGY CENTER Please check to see that you have all of the required documents. Incomplete applications will not be considered.

Documents Required From All Applicants

__________ Surgical Technology Application

__________ Official completed high school transcript with GPA and graduation date or

GED scores

__________ College Transcript(s) – If applicable

__________ TABE scores and CAPS & COPS scores

__________ Three (3) completed work reference forms from supervisors or teachers

International Students Only __________ TOEFL Score

**Once complete please submit to the Career Advisor at 3 CT Circle, Drumright, OK 74030.**

SURGICAL TECHNOLOGY APPLICATION

PLEASE TYPE OR PRINT INFORMATION:

In Which School District Do You Reside:__________________ SS#______-______-______ (Optional - Required at enrollment)

Full Legal Name: __________________________________________________________________________

(First) (Middle) (Maiden) (Married)

________________________________________________________________________________________

(Street # & Name, or P.O. Box)

(City) (State) (Zip)

Home Telephone Number: ( ) Work Number: ( )

Cell Phone Number: ( ) E-Mail Address:

In case of emergency, please notify: (Please list someone who will always know your whereabouts)

(Name) (Relationship) (Home Phone) (Work/Cell Phone)

Present Occupation: Employer:

Current Employer's Address:

(Street # & Name, or P.O. Box) (City) (State) (Zip)

Past Employer's Address:

(Street # & Name, or P.O. Box) (City) (State) (Zip)

Circle highest grade completed: 7 8 9 10 11 12 GED College: 1 2 3 4 (Attach an official copy of your high school transcript or GED SCORES and college transcripts as applicable.)

Have you ever enrolled in and/or graduated from a Surgical Technology program before? Yes_____ No ____

If yes, name of School:

Dates of Attendance:

If you did not graduate, reason for leaving previous school :

Have you ever attended a career and technology center in the past? Yes No

Have you ever attended a career and technology center in the past? Yes No

If yes, name and date of school and program attended:

Name of school: Date

Program attended:

Are you seeking financial aid? Yes____ No______ If you are seeking financial aid from any agencies such as

W.I.A., V.A., B.I.A., or Voc-Rehab, please list the agency and your counselor's name:

How did you hear about Central Technology Center?

Radio/TV _____ Newspaper _____ Friend _____ Website _____

Will you need accommodations or modifications in order to successfully perform the essential functions of the

assessment and/or occupational program in which you enroll? If yes, please describe:

Have you ever been arrested for any offense other that traffic violation or minor offense? Yes_____ No_____

Have you ever been convicted of any offense, including a deferred sentence, within the past five years, with

the exception of any offense expunged under 63.0§1981 2-410? Yes______ No_____

Do you have a record of a felony conviction, even if conviction has been expunged?

No ____ Yes____ (If yes, you will need to provide an official copy of your conviction record)

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY

KNOWLEDGE AND UNDERSTAND THAT, IF ENROLLED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE

GROUNDS FOR TERMINATION.

DATE: SIGNATURE:

Central Technology Center, in compliance with Title VI of the Civil Rights Act of 1964, Title VII and Title IX of the

Education Amendments of 1974, Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA), does

not discriminate on the basis of race, color, religious creed, national origin, age, sex/gender, disability or veteran status in any

of its policies, practices or procedures. These equal opportunity provisions include, but are not limited to, admissions,

employment, financial aid, and educational services.

CENTRAL TECH SURGICAL TECHNOLOGY

WORK HISTORY

1. Have you ever been discharged from employment or resigned to avoid such discharge?

Yes ________ No ________

2. Have you ever been arrested for any offense or convicted of any offense, including a deferred

sentence, within the past five years with the exception of any offense expunged under 63

O.S.§1981 2-410? Yes _______ No _______

3. Work References: (List most recent within last 5 years)

a)

Name of Employer Supervisor

Business Address City State Zip Dates of Employment

__________________________________ _________________________________

Job Title Reason for Leaving

b)



__________________________________ _________________________________


c)



__________________________________ _________________________________


d)



__________________________________ _________________________________


Reference for: ________________________________________


APPLICANT’S WORK REFERENCE

The address of the person you are requesting the reference from goes below.

TO: ________________________________________

________________________________________

________________________________________

Mr. Ms. ____________________________________ has applied for admission to Surgical Technology

at Central Technology Center and has given us your name as a reference. In order to be considered for

this instruction, we need your candid opinions as to the applicant’s suitability to perform the duties

required of a surgical technologist. ALL INFORMATION WILL BE KEPT CONFIDENTIAL.

PLEASE RETURN THIS REFERENCE TO ONE OF THE CAREER ADVISORS BELOW.

Joni Carroll, 3 CT Circle, Drumright OK 74030

Thank you for your time.

1. How long have you known the applicant? _________________________________________

2. In what relationship have you known the applicant? ________Supervisor _______Teacher

_______Other (specify)___________________________________________________________

1 – Poor 2 – Average 3 – Above Average 4 - Exceptional

Attendance

Tardiness

Work Ethic

Enthusiasm

Loyalty

Confidentiality

Professionalism

Ability to manage stress

Maintains appropriate

working

relationships with peers and

employer

Please use the back of this form to make any additional comments you may have. Thank you.

Signature:________________________________________ Date:_______________________

Title: _______________________________________ Phone:___________________________

Reference for: ________________________________________




TO: ________________________________________

________________________________________

________________________________________





PLEASE RETURN THIS REFERENCE TO ONE OF THE CAREER ADVISORS BELOW.





_______Other (specify)__________________________________________________________


Attendance

Tardiness

Work Ethic

Enthusiasm

Loyalty

Confidentiality

Professionalism



working


employer


Signature:________________________________________ Date:_______________________

Title: _______________________________________ Phone:___________________________

Reference for: ________________________________________




TO: ________________________________________

________________________________________

________________________________________





PLEASE RETURN THIS REFERENCE TO THE CAREER ADVISORS BELOW.





_______Other (specify)____________________________________________________________


Attendance

Tardiness

Work Ethic

Enthusiasm

Loyalty

Confidentiality

Professionalism



working


employer


Signature:________________________________________ Date:_______________________

Title: _______________________________________ Phone:___________________________