Surgical Technology Program Application and Information Packet

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PRCC SUT Program Application Packet (2016 Class) Page 1 of 18 (Rv’d 8-2-15 TA)

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SURGICAL TECHNOLOGY PROGRAM

Surgical Technology Program

Application and Information Packet

SUT Department

Location: Mailing Address:

Forrest County Campus PRCC

Allied Health Building # 6 5448 US Hwy 49 South

SUT Department Rm # 119 Hattiesburg, MS. 39401

SUT CONTACT INFO:

Tammy Allhoff, CST, CSFA, A.A.S. Brittney Hawkins, CST, A.A.S. SUT Program Director/Instructor SUT Clinical Coordinator/Instructor [email protected] 601-554-5542 [email protected] 601-554-5542

Cheryl Breland, SUT Secretary [email protected]

601-554-5507

AH Building Room # 224

All statements in this publication are announcements, present policies and procedures only, and are subject to change at any time by proper authority and without notice.

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PRCC SUT Program Application Packet (2016 Class) Page 2 of 18 (Rv’d 8-2-15 TA) PRCC

SURGICAL

TECHNOLOGY

PROGRAM

Dear SUT Applicant:

Thank you for your interest in the Pearl River Community College Surgical Technology Program. Today, surgical technologists are working in one of the fastest growing professions in the country. The US Bureau of Labor Statistics projects that the surgical technology profession will grow faster than the average of all other occupations through the year 2020, and it is anticipated that the volume of surgery will increase exponentially due to the expanding senior population.

Deadline to apply for the SUT Program is 4:00 p.m on October 1st each year. File must be complete by this deadline to possibly be considered for an interview. If accepted, classes will begin the following January.

It is recommended that you contact the SUT Instructors for advisement and possibly schedule an appointment for advisement. All financial aid information and applications can now be obtained online at www.prcc.edu or you may contact the Financial Aid Office at 601-554-5534 or 601-403-1029.

If we may provide any assistance during the application process, please do not hesitate to call or contact us. If you need any additional information you should contact SUT Department.

Sincerely,

Tammy Allhoff,

CST, CSFA, A.A.S.,

SUT Program Director

Access the current PRCC catalog at http://www.prcc.edu

Access SUT Information at www.prcc.edu Academics Career/Technical Surgical Technology

About The Program

Surgical Technology students receive an in depth practical knowledge and essential clinical education related to the OR. The PRCC Surgical Technology Program not only includes intensive hours in the classroom, but also extensive clinical experience in health care facilities. Students study anatomy and physiology, microbiology, pharmacology, principles of asepsis, surgical techniques, patient preparation, and care of surgical instruments and equipment.

Surgical Technology students will learn to become integral members of the surgical team and will work closely with surgeons, anesthesiologists, registered nurses, and other surgical personnel delivering patient care before, during, and after surgery. In addition to the hospital OR, surgical technologists may be employed in Labor & Delivery, Central Sterile Processing departments, Supply/Purchasing, Outpatient Clinic and Surgery facilities, sales representatives for medical product companies as well other career opportunities that may be available.

The Surgical Technology Program is a one plus one year program. A Surgical Technologist may graduate after one year with a Certificate of Proficiency or may continue on for an Associate in Applied Science degree. The Associate Degree may also be obtained through previous coursework. All SUT courses have to be taken in sequence and consecutively within timeframe of SUT Program to complete/graduate from the SUT Program.

Accreditation Status

The Surgical Technology Program at PRCC is accredited by the Commission on Accreditation of Allied health Education Programs (CAAHEP).The program received reaffirmation of accreditation on May 19, 2008 for a period of 10 years. CAAHEP 1361 Park Street, Clearwater, Florida, 33756 Ph: 1-727-210-2350

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Professional Affiliates

 AST The Association of Surgical Technologists- The oldest and most widely recognized professional organization for surgical technologists. AST actively promotes education for the profession, legislatively advocated for practitioner recognition, supports state-level constituent organizations, and has committed to students as the future of the profession. www.ast.org

 ARC/STSA Accreditation Review Council on Education in Surgical Technology and Surgical Assisting- Provides recognition for the quality of the education programs in its system to the public. The ARC/STSA is the only CAAHEP-recognized committee on Accreditation for education programs in surgical technology and surgical assisting. www.arcstsa.org

 CAAHEP The Commission on Accreditation of Allied Health Education Programs - The largest programmatic accreditor in the health sciences field, reviewing over 2,000 educational programs in 26 health science occupations. www.caahep.org

 NBSTSA The National Board of Surgical Technology and Surgical Assisting- Promotes the highest level of professional certification of surgical technologists (CST) and surgical first assistants (CFSA), thus promoting quality patient care in the surgical setting. www.nbstsa.org

TECHNICAL ABILITIES, PROFESSIONAL BEHAVIOR AND COGNITIVE REASONING REQUIRED

FOR THE SURGICAL TECHNOLOGY PROGRAM

To provide the minimum standard of patient care, the Surgical Technology student must exhibit the following occupational skills and behavior. This list is not all inclusive.

1. Use fine motor skills and hand-eye coordination, using both right and left hands that allow the students to safely manipulate needles, blades, sutures, and instruments.

2. Perform a full-range body motion, including moving patients and handling, lifting, and pushing heavy equipment.

3. Bend, reach, pull, push, stand, stoop, and walk during educational experiences. 4. Possess physical stamina, as long periods of standing are required.

5. Demonstrate visual acuity (with correction, if needed) within normal range including peripheral vision and reading of fine print.

6. Demonstrate auditory acuity (with correction if needed) that includes hearing muffled voices (through a mask) with background noise.

7. Wear full surgical attire including personal protective devices. 8. Withstand unusual sights and smells, such as cauterized tissue.

9. Adapt effectively and use appropriate coping skills in environments with high stress to ensure patient safety.

10. Respond quickly and in an emotionally controlled manner in emergency situations

11. Recognize that the work environment will include exposure to diseases and toxic substances.

12. Function during procedures or situations that require analytical or critical thinking even during stressful situations.

13. Multitask during all phases of patient care.

14. Use critical thinking to problem solve when unusual situations arise.

15. Anticipate the needs and provide emotional support to team members and the patient.

16. Properly document required paperwork in an objective, concise, professional and legible manner. 17. Demonstrate attentive behavior by focusing intently on the task at hand.

18. Integrate and prioritize duties.

19. Adapt to various assignments and Clinical rotations and possibly work irregular hours. 20. Possess a stable temperament and handle constructive criticism.

21. Communicate in a rational and coherent manner both orally and in writing. 22. Perform at an acceptable standard skill set.

23. Provide quality patient care and follow all safety requirements. 24. Adhere to AST Code of Ethics.

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SUT CURRICULUM DESCRIPTION

SUT Curriculum & Program requirements may be revised as necessary 1113 Fundamentals of Surgical Technology (3)

This is a basic introductory course including hospital and surgical suite organization and environment, history, legal responsibilities, terminology, interpersonal relationships, and biomedical sciences. (3 sch. 3hrs. lecture) Co-requisites: All 1st_{semester courses}

1216 Principles of Surgical Technique (6)

This course is a comprehensive study of aseptic technique, safe patient care, anesthesia, pharmacology, and surgical techniques. (6 sch. 2 hr. lecture, 8 hrs. lab) Co-requisites: All 1st_{semester courses}

1413 Surgical Microbiology (3)

This is an introduction to pathogenic microorganisms related to surgery and their effect on wound healing and infection. It includes principles of sterilization and disinfection. (3 sch. 3 hrs. lecture)

Co-requisites: all 1st_{semester courses}

1314 Surgical Anatomy (4)

Emphasis is placed on structure and function of the human body as related to surgery. A study of medical terminology and application of the principles of surgical anatomy are emphasized and related to the clinical experience. (4 sch. 4 hrs. lecture) Co-requisites: All 1st_{semester courses}

1518 Basic and Related Surgical Procedures (8)

This course includes instruction in regional anatomy, pathology, instrumentation, and surgical techniques in general surgery, gynecology, obstetrics, urology, minimally invasive endoscopic and robotic-assisted surgeries. It requires clinical experience in area hospital surgical suites and related departments as well as proper clinical documentation. (8 sch. 4 hr. lecture, 12 hrs. clinical)

Pre-requisites: All 1st_{semester courses}

1528 Specialized Surgical Procedures (8)

This course includes instruction in regional anatomy, pathology, instrumentation, and techniques in surgical specialty areas of ear, nose, and throat; ophthalmology; plastic and reconstructive; oral & maxillofacial;

orthopedics and neurosurgery. This course requires clinical experience in area hospital surgical suites and related departments as well as proper clinical documentation (8 sch. 4 hrs. lecture, 12 hrs. clinical)

Pre-requisites: 2nd_{semester course Co-requisites: SUT 1538, 1703}

1538 Advanced Surgical Procedures (8)

This course includes instruction in regional anatomy, pathology, instrumentation, and techniques in surgical specialty areas of thoracic and pulmonary, peripheral vascular, cardiac, and trauma surgery. This course requires clinical experience in area hospital surgical suites and related departments as well as proper clinical documentation and a comprehensive final examination. (8 sch. 4hrs. lecture, 12 hours clinical)

Pre-requisites: 2nd_{semester course Co-requisites: SUT 1528, 1703}

1703 Certification & Role Transition (3)

This course examines the role for the surgical technologist in a variety of settings and required of various job descriptions and or departments. We will also explore adaptive critical thinking skills in a variety of settings, effective team and professional behaviors, continuing education, and sterile technique applications. This course also helps prepare the student to sit for the National Certification Exam for surgical technologists including review and eligibility documentation. Employability skills, paperwork and preparation will be discussed along with examining duties and requirements necessary for different roles or job duties. Certification requirements and maintenance will also be covered. This course will cover all material taught in SUT 1314, 1413, 1216, 1113, 1518 and material that will be currently taught in SUT 1528 & 1538.

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Surgical Technology Program of Study

Students may graduate in 1 year with a Certificate of Proficiency or graduate with an A.A.S. Degree if they have previous coursework or want to continue taking academics required for the A.A.S. Note: All SUT classes must be passed with a “C” or higher and a 2.0 GPA must be maintained

Certificate of Proficiency Curriculum__ _Total: 46 Hours_____ __January- December______________

(1st_{semester) -Spring} _{* sch = semester credit hours}

3 sch SUT 1113 Fundamentals of Surgical Technology 6 sch SUT 1216 Principles of Surgical Techniques

4 sch SUT 1314 Surgical Anatomy 3 sch SUT 1413 Surgical Microbiology

3 sch ENG 1113 English Composition I (unless previously taken) 19 sch

(2nd_{semester) - Summer}

(Pre-requisites: All 1st_{semester courses)}

8 sch SUT 1518 Basic and Related Surgical Procedures

(3rd_{Semester) Fall}

(Pre-requisites: 2nd_{semester course)}

8 sch SUT 1528 Specialized Surgical Procedures 8 sch SUT 1538 Advanced Surgical Procedures 3 sch SUT 1703 Certification & Role Transition 19 sch

OPTIONAL

Associate in Applied Science Degree Curriculum TOTAL: 76 Hours___________

Includes all coursework required for the Certificate of Proficiency in addition to the curriculum listed below

(1st_Semester)

3 sch Oral Communications Elective 4 sch Microbiology with LAB * 4 sch A&P I with LAB*

3 sch Approved Elective

14 sch

(2nd_Semester)

3 sch Humanities/Fine Arts Elective 3 sch Social/Behavioral Science Elective 3 sch Math/Natural Science Elective

4 sch A&P II with LAB* 3 sch Approved Elective

16 sch

***Approved Electives***

General Biology I (BIO 1134) General Biology II (BIO 1144) Nutrition (FCS 1253) Algebra (MAT 1313 or higher)

Introduction to Sociology (SOC 2113) Marriage and Family (SOC 2143)

General Psychology (PSY 1513) Human Growth and Development (EPY 2533) Child Psychology (EPY 2513) Adolescent Psychology (EPY 2523)

First Aid/CPR (HPR 2213) General Chemistry I (CHE 1213) with Lab (CHE 1211)

Computer Concepts (CSC 1113) Concepts of Microcomputer Applications (CPT 1113) Personal and Community Health I (HPR 1213) Personal Community Health II (HPR 1223)

Medical Office Terminology I (BOT 1613) Medical Office Terminology II (BOT 1623) Business Management and Microcomputers (BAD 2533)

* Indicates pre-requisites may be required

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PRCC SUT Program Application Packet (2016 Class) Page 6 of 18 (Rv’d 8-2-15 TA) SUT Program Student Estimated Fee Sheet (Academic Year: August 2015- July 2016)

Spring Semester

Tuition* (in state) ……… 1,325.00 Program Fee ………. 400.00 Registration Fee ……… 25.00 Technology Fee ……….… 25.00 Parking Permit ……….. 20.00 Books** ……….………...………….. 500.00 AST Student Membership ……… 45.00 Liability Insurance ……….. 15.00 Maroon Scrubs (x2 pair) ** ……… 100.00 Warm-Up Jacket (optional) ** ……….. 20.00 Clinical Shoes** ………... 50.00 HBV vaccine (1st) ** ……… 55.00 HBV vaccine (2nd) ** ……… 55.00 Tetanus Shot** ………. 10.00 CPR-C certification (healthcare provider) ** ……… 30.00 Criminal Background Check ………. 50.00 Document Tracker ……… 30.00

Flu Vaccination**……… 30.00 10 panel Drug Screen ……… 69.00

Physical Exam** ……….. VARIES Health Insurance** ……… VARIES Auto Insurance** ……… VARIES

Approximate Semester Total $2,854.00

Summer Semester

Tuition* (in state) ….……….. 920.00 Program Fee ……….………. 400.00 Registration Fee ………. 25.00 Technology Fee ……… 25.00 Books** …………..……….… 200.00 HBV vaccine (3rd) ………... 55.00

Fall Semester

Tuition* (in state) ………. 1,325.00 Program Fee ………... 400.00 Registration Fee ………. 25.00 Technology Fee ………. 25.00 Parking Permit ……….. 20.00 Year disk ……….. 3.00 Liability Insurance ……….………… 15.00 Graduation Pin ……….………. 45.00 CST Exam ……….. 190.00 Flu Vaccination**………... 30.00

Prices are subject to change without notice

*Out-of-State calculated from the PRCC 2015 Fiscal Year Fee Sheet

Spring Semester ………. Additional tuition fees $1,199.00 Summer Semester……… Additional tuition fees $800.00 Fall Semester ……….. Additional tuition fees $1199.00

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G

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Criteria:

 Applicant must be 18 years of age.  Applicant must have ACT score of:

16 or above (minimum score of 18 preferred)

*Applicants with an ACT score below 16 do NOT meet the required criteria and will not be considered for SUT interviews or admission

 Transcripts may be sent using eScript Step 1:

______ (yes*) ______ (no) Are you currently enrolled at Pearl River Community College?

If yes*: ___________________ (PRCC ID #) and SKIP to Step 6. If no: Proceed to Step 2 Step 2:

Have you attended PRCC in the last 5 years?

____________ (yes*) _______________ (no) If no, proceed to Step 3.

If yes*: ___________________ (Dates attended) and SKIP to Step 5. If no: Proceed to Step 3 Step 3:

If you have never attended Pearl River Community College, or you have not attended within the last 5 years, you will need to send or bring the following documents to the Admissions Office:

 High school transcripts with GPA calculated on a 4.0 scale or GED scores  ACT score(s) (make sure to provide us with the highest score)

 Official transcripts from all colleges or universities you have ever attended Step 4:

_______ (yes*) ______ (no) Have you attended any other Colleges or Universities other than or since your enrollment at PRCC?

If yes*: You will need to send all transcripts of other Colleges or Universities attended to PRCC. Transcripts may be sent via eScript. Transcript Release included in this packet. Proceed to Step 5.

If no: Proceed to Step 5.

Step 5: All applicants must complete a Pearl River Community College Application online @ prcc.edu. Step 6: All applicants must provide Proof of Residency as required (Info included in this packet).

Step 7: Program Specific

SUT applicants must complete the following documents. You may send them to PRCC: Attention Surgical Technology Department or hand deliver them in a sealed envelope with your name, date and Attention: Surgical Tech Department on the envelope. Please follow up via e-mail with [email protected] to verify our receipt of required document.

 SUT Application (located in this packet)  Autobiographical Essay (located in this packet)

Thank you for your interest in our Allied Health Program and Pearl River Community College. We look forward to assisting you with reaching your goal and achieving success.

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PRCC Admissions Office: SUT Department:

Pearl River Community College Pearl River Community College

Attn: Admissions Attn: Surgical Technology Department

5448 US Hwy 49 South 5448 US Highway 49 South Hattiesburg, MS 39401 Hattiesburg, MS 39401

Or you may hand deliver the documents to:

Pearl River Community College Pearl River Community College

Admissions Office Allied Health Building

Allied Health Building Room 119 SUT Department

or SUT secretary (Cheryl Breland) Room 244

SELECTION PROCESS.

NOTE: Priority in student admission will be given to (1) in-district candidates, (2) of-district candidates and (3) out-of-state candidates.

 Only completed applicant files will be considered for a possible Interview.  ACT Score has to be a minimum of 16 (Preferably 18 or higher)

 Completed file (PRCC Application, SUT Application, all transcripts, ACT score, SUT Autobiography)  All applicants will be sent a confirmation e-mail once their application file is complete.

 Applicants are ranked according to most recent GPA and ACT score. Highest ranking applicants may be considered for an interview. A maximum of 60 applicants will be invited for an Interview.

 Interview candidates will be ranked according to ACT, GPA and Interview score. Interviews will be

conducted by a selection committee and candidates need to be prepared for a professional Interview setting.  Class candidates will be notified and final acceptance to the class will depend on meeting criteria to be

discussed during a Mandatory Orientation Session. Any student who does not attend may forfeit their slot for the upcoming class.

 SUT class size is limited to up to 20 (maximum) slots.

Candidate requirements that will be discussed during the Mandatory SUT Orientation Session:

1. For those candidates offered a position in the upcoming class, specific requirements and deadlines will have to be met or you may lose your position in the class and the open position may then be filled with an Alternate. Students are financially responsible for the following requirements and most of the requirements must be met prior to classes starting in January.

2. Due dates, requirements and deadlines will be given and discussed during the SUT Orientation Session.

Do not begin to obtain any of the following until after the Orientation Session. A. TB Skin Test (Tuberculin Mantoux/ Cleared chest x-ray if skin test is positive) B. Hepatitis B immunization series or declination waiver

C. Completed Primary DPT Series (Form #121- Certificate of Immunization Compliance)

D. Tetanus shot within the past 10 years E. CPR Certification- C (Healthcare Provider)

F. Physical Exam G.10 panel Drug Screen with negative results H. Cleared Criminal Background Check

I. Proof of Health Insurance J. Current Auto Insurance K. Current Driver’s License L. 2 Letters of Recommendation (Professional) M. AST membership N. Flu shot each flu season O. Additional requirements may need to be met at the request of the various clinical sites.

3. Depending on the number of qualified applicants, some students may be placed on an

Alternate list to possibly fill any vacancies. This Alternate list will void on or near the late registration date. 4. AH Program notes.

 Surgical Technology students may be randomly selected for a drug screening at any time during the course of the program, and student will be responsible for all associated costs.

 Surgical Technology students may be exposed to various blood borne pathogens, infectious diseases, blood and bodily fluids. Universal and Standard Precautions as well as PPE (personal protective equipment) will be covered during the didactic and Clinical portions of the SUT Program.

 Health Care Criminal History Background Check: Candidates for Allied Health/Nursing Programs may be required to submit fingerprints for a Criminal Background Check in accordance with Mississippi State Law. This process may be required by Clinical Sites. If any candidate is found to have a disqualifying event on

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their background check, they may be prohibited from attending Clinicals and therefore will not meet Clinical criteria and will not be allowed to continue in the Program.

Graduation Requirements:

Students are required to scrub on a minimum of 120 surgical cases meeting specific requirements. Prior to completion of the program, the students are required to sit for the National Certification Exam for Surgical Technologists Administered by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) as part of the graduation requirements. The Outcomes Assessment Exam (OAE) pass-rate from the program’s graduates reported in spring of 2015 was 92% passage rate. As part of the program and graduation

requirements, students are required to pass all SUT required classes with a “C” or higher and a minimum of a 2.0 GPA.

____________________________________________________________

Attention All Applicants:

If you have not heard from us within 2 weeks of submitting your application, please contact us via e-mail. You may need to also contact us sometime in September as the deadline to apply is October 1.

Tammy Allhoff, SUT Program Director, [email protected] Brittney Hawkins, Instructor, [email protected]

Cheryl Breland, Secretary, [email protected]

__________________________________________________________________________________________ Residency Proof:

Admission’s office requirements needed to prove in-state residence, a student must submit the following items:

Student 21 years or older or Married Students under 21 years old

1. A valid Mississippi Driver License 1. Parent’s valid Mississippi Driver License

NOTE: Every student must submit a MS Driver’s License.

Plus every student must submit one of the following items:

1. Mississippi Automobile Registration or 1. Parent’s Mississippi Automobile Registration 2. Mortgage paperwork or lease agreement or 2. Parent’s Mortgage paperwork or lease agreement 3. Utility bill (electric, telephone, water) or 3. Parent’s Utility bill (electric, telephone, water) 4. MS Income Tax Return or 4. Parent’s MS Income Tax Return

5. Homestead exemption (if home owner) or 5. Parent’s Homestead exemption (if home owner) 6. MS County voter registration card or 6. Parent’s MS County voter registration card 7. Marriage License, if under age 21

__________________________________________________________________

Financial Aid Assistance:

Forrest County: 601-554-5502 Poplarville: 601-403-1211

________________________________________________________________________________________ PRCC Offers equal education and employment opportunities. We do not discriminate on the basis of race, religion, color, sex, age, national origin, veteran status, or disability. For inquiries regarding the

non-discrimination policies or to request accommodations, special assistance, or alternate format publication please contact Tonia Moody, ADA/Civil Rights Coordinator, at P.O. Box 5118, Poplarville, MS 39470 or 601-403-1060.

If you have a disability that qualifies under the Americans with Disabilities Act and you require special

assistance or accommodations, you should contact the designated coordinator for your campus for information on appropriate guidelines and procedures: Forrest County Center, Kirk Powell at 601-554-5530 or

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SUT Application for Admission Date________________

Birthdate _______________Social Security #:___________________________ PRCC ID#______________________ Name: ___________________________________________________________________________________________

Last First Middle (Maiden)

Address: _________________________________________________________________________________________ City: ____________________________________ State: _____________________ Zip Code: _____________________ Phone: _______________________________________ (day) ________________________________________ (other) ACT Score:_______ Composite Date Taken______________ (Sub scores) E_____ M_____ R_____ S_____

E-Mail: ____________________________________________________________ (E-mail will be how we correspond with you,

Make sure address is printed and legible)

Have you previously applied to the PRCC Surgical Technology Program? ______ Yes _____ No If yes, what year _____________________________

Have you attended any other colleges/universities? ______ Yes _____ No

If yes, please list name of other schools attended: __________________________________________________________ __________________________________________________________________________________________________ Have you ever been convicted of a misdemeanor or a felony? _____ Yes _____No

If you answered yes to the question above, please list the conviction(s) below.

Date: Conviction:

_____________ _________________________________

Required Identifying Documents:

 A 2 inch by 2 inch color passport quality photo (white background only) with your name

printed on the back of the photo. Photo must be taped to the SUT application in the specified location

Pearl River Community College offers equal education and employment opportunities. We do not discriminate on the basis of race, religion, color, sex, age, national origin, veteran status, or disability. For inquiries regarding the non-discrimination policies or to request accommodations, special assistance, or alternate format publication please contact Tonia Moody, ADA/Civil Rights Coordinator, at P.O. Box 5118 Poplarvi lle, MS 39470 or (601) 403-1060

TAPE PHOTO

HERE

Please write your name on the back of

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PRCC SUT Program Application Packet (2016 Class) Page 13 of 18 (Rv’d 8-2-15 TA) This page left intentionally blank

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HIGH SCHOOL/COLLEGE TRANSCRIPT RELEASE FORM

Please complete this form and send to the High school and or Colleges you have attended. Notice to High School or College: Please send an official Transcript for the following

Pearl River Community College Surgical Technology Program applicant. Please send via eScript.

Name: _______________________________________________________________________ (Last) (Maiden) (First) (Middle)

Date of Attendance/Graduation: __________________________________

SOCIAL SECURITY NUMBER: ________________________________

I am requesting the records department of ____________________________________________

(Name of High School/College you attended)

To release my transcript to:

Pearl River Community College Attn: Admissions/SUT Program 5448 US Hwy 49 South

Hattiesburg, MS 39401

Signature: __________________________________________ Date: ______________

** High school transcripts must include cumulative GPA based on a four-point scale.

Please be sure to request that your GPA is calculated and documented on your high school

transcript

NOTICE TO APPLICANT: Please be sure to send this form to the High School or College that you need the school transcript request from. Do not send this form back to the PRCC. If you do, and we do not receive your transcript(s), by the October 1st deadline, your file may be considered incomplete. It is your responsibility to send this form to the necessary school(s).

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AUTOBIOGRAPHICAL ESSAY

Write an autobiographical essay explaining your interest in the field of Surgical Technology, emphasizing those which would enhance your career as a Surgical Technologist, and why you would make a good candidate for the SUT Program. You may also include examples of your participation in activities (community service, extracurricular, etc.) Your essay should be limited to this sheet of paper. Essay must be handwritten, not typed.

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PRCC SUT Program Application Packet (2016 Class) Page 18 of 18 (Rv’d 8-2-15 TA) SUT Program Application Checklist Deadline to apply: October 1st

This application checklist is provided to assist you in ensuring that you have completed the application process. Each time you submit a required document, date when you sent it so you will have a record of your application activity.

________________________ PRCC Application for Admission (online submission)

________________________ High School Transcript- Sent to Admissions via eScript (if not already in Admissions)

________________________ All College Transcripts- Sent to Admissions via eScript (if not already in Admissions)

________________________ ACT Scores (if not already in Admissions)

________________________ Proof of Residency

________________________ General Admissions Form

________________________ Mississippi Driver’s License (valid and current)

You may send the following documents to PRCC: Attention Surgical Technology Department or hand deliver them in a sealed envelope with your name, date and Attention: Surgical Tech Department on the envelope. Please follow up via e-mail with [email protected] to verify our receipt of required documents.

___________________________ SUT Application (located in this packet)

___________________________ Autobiographical Essay (located in this packet)

___________________________ e-mail verification of my correct e-mail address

___________________________ e-mail verification of Application received by SUT

___________________________ e-mail confirmation of complete file