PROGRAM
APPENDICES
Surgical Technology Program Information
I. PURPOSE
This is a ten month accredited program. It is accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). 1 Eli Whitney and A. I. Prince are accredited by the Council on Occupational Education (COE). 2 The purpose of the Surgical Technology Program is to educate qualified individuals in becoming a member of a surgical team in the perioperative care of patients within the scope and limitation of the surgical technologist’s role. The Surgical Technologist’s role is to assist in the preparation and maintenance of the surgical sterile field as well as functioning as an assistant to the surgeon throughout the surgical procedure. The Surgical Technologist is an integral member of the surgical team.
The first part of the program emphasis is concentrated on classroom didactic and clinical instruction. Classroom instruction breakdown is mapped out in the Master Curriculum that precedes this section. The courses and the clinical practice section of the master curriculum are conducted on the school campus. The clinical externship is conducted at various local hospitals. The clinical sites contracted for A.I. Prince include: Hartford Hospital, St. Francis Hospital, John Dempsey Hospital, Farmington Surgical Center and Bristol Hospital. The clinical sites contracted for Eli Whitney include: Yale New Haven Hospital (Temple Surgical Center), Yale New Haven Hospital (St. Raphael’s Campus), St. Raphael’s Hospital, West Haven Veterans’ Administrative Hospital, Griffin Hospital, Waterbury Hospital and St. Vincent’s Medical Center. The students function under the direction of the instructors as well as a hospital appointed Surgical Technologist, or Registered Nurse in the clinical externship when performing the skills of the surgical technologist.
1
Commission on Accreditation of Allied Health Education Programs (CAAHEP), 1361 Park Street, Clearwater, Fl. 33756. Telephone: (727) 210-2350, Fax (727) 210-2354, email address: [email protected].
2 Council on Occupational Education (COE), 7840 Roswell Rd., Building 300, Suite 325, Atlanta, Georgia, 30350, Telephone (Local) 770-396-3898, Telephone (Toll-Free) 800-917-2081, Fax 770-296-3790.
The Connecticut Technical High School System is committed to respond to community needs by producing skilled practitioners with the ability to communicate effectively within the world of work; and attain gainful employment and job satisfaction.
Ongoing evaluation of the attainment of curriculum goals is the responsibility of the faculty with input from students, employers and consumers.
Continuing education reflects a commitment to professional growth and is the individual’s responsibility. II. PHILOSOPHY OF THE SURGICAL TECHNOLOGY EDUCATION
The faculty of the Surgical Technology Program believes that:
Every person is a special being of great worth with inherent rights and possessing commonalties of basic physical, social, emotional and spiritual needs which create a cultural diversity and impact the community, defined as a network of interacting individuals, social systems and groups and extends throughout the life span.
Health is a state, which reflects holistic balance allowing the individual to self-actualize and express his/her optimum function. This is seen as a wellness/illness continuum. Wellness is achieved by a balance of body, mind and spirit. Illness is an alteration of this balance.
Education is an ongoing democratic process for assisting people to realize their potential through self-actualization. It is the process of personal enrichment through which the student learns to communicate and interact with others.
Connecticut Technical Education is committed to respond to community needs by producing skilled practitioners with the ability to communicate effectively within the world of work; and attain gainful employment and job satisfaction.
Ongoing evaluation of the attainment of curriculum goals is the responsibility of the faculty with input from students, employers and consumers.
Continuing education reflects a commitment to professional growth and is the individual’s responsibility. III. MISSION STATEMENT
The mission of the Surgical Technology Program coincides with the mission of the Connecticut Technical School System. It ensures the student both academic and clinical success and instills a zest for lifelong learning. It establishes a safe and comprehensive learning environment where everyone is accountable, respectful and committed to the betterment of themselves and the community. This is acquired through accountability, respect and rigors in teaching and learning.
IV. CONCEPTUAL FRAMEWORK
The role of the Surgical Technologist is challenging and diverse. Surgical Technologists are integral members of the surgical team who work closely with surgeons, registered nurse and anesthesia personnel. It is important for Surgical Technologists to be team players. They often work in stressful situations that require physical endurance, a stable temperament, manual dexterity and efficiency.
Surgical Technologists are primarily responsible for passing instruments, suture materials and supplies to the surgical team during an operation. They are experts in sterile technique and responsible for monitoring and maintaining the sterile field during surgery. They must be able to react quickly, pay attention to detail and manage multiple demands at one time. Surgical Technologists should have a genuine concern for the well-being and safety of the patient.
Health care reform has provided new opportunities for Surgical Technologists to practice in expanded roles, such as the Circulating Surgical Technologist and the First Assistant Surgical Technologist. The scope of practice for Surgical Technologists continues to grow and become more challenging as the demand for well educated, highly skilled care providers increases.
V. PROGRAM OBJECTIVES
At the completion of the Surgical Technology Program, the graduate will be able to:
1. Apply the knowledge of anatomy, physiology, microbiology and pharmacology to the care of the perioperative patient as it relates to the role of the Surgical Technologist.
2. Demonstrate perioperative technical skills and knowledge in a safe and effective manner. 3. Attain comprehensive of ethical, legal, moral and cultural issued related to patient care and
the surgical team.
4. Exhibit safe practice methods involving preparation routines of the intraoperative environment, patient positioning and emergency procedures.
5. Display and incorporate aseptic principles in the intraoperative setting.
6. Utilize knowledge and skills to attend to the physical, psychological and social needs of the patient.
7. Perform as a competent entry-level Surgical Technologist in the cognitive, psychomotor and affective learning domains.
8. Recognize the importance of and exhibit the professional attributes of the Surgical Technologist.
9. Qualify to sit for the national certification exam. VI. SCHOOL STUDENT WORK
Objective: To inform the students of the conduct and responsibilities required by the program with regard to the clinical externship.
1. All students’ activities while completing the clinical rotation will be educational in nature only.
2. The student will not receive or accept any monetary compensation for the hours of their educational externship experience.
3. The student will not be substituted for hired staff as a surgical technologist at the clinical facility per the signed contractual agreement made with each clinical facility site.
4. During all clinical externship hours the student will be provided a clinical preceptor that will be present and scrubbed on all cases.
5. The student will fulfill an eight hour shift in accordance with the clinical facilities daytime shift schedule.
6. The student will follow all the policies and procedures of the clinical facility.
7. The student will attend clinical in-services as deemed appropriate by the clinical facility. 8. The student should attend any clinical staff meeting as deemed appropriate by the clinical
facility.
VII. CLASSROOM AND LABORATORY RULES BEHAVIOR
Professional behavior is expected at all times by the students both in class and laboratory. Respect and courtesy will be given to everyone associated with the program. Bad language and foolish behavior will not be tolerated.
Students are expected to report on time for classroom, laboratory and clinical externship. Cheating is grounds for dismissal.
Tests should be checked front and back before handing in to the instructor to ensure that all questions are answered.
It is encouraged that personal needs such as eating and going to the bathroom be taken on scheduled breaks. This is in preparation for being in the clinical environment where one cannot leave until relieved.
Students are to be awake, attentive and courteous at all times. Eating, drinking, chewing gum are ONLY permitted during breaks in designated areas at the school and the affiliating agencies. SMOKING is not allowed on state property at any point in time, not even in their cars in the parking lot.
Required text books, needed supplies, etc., must be available for all classes. Students are not to look at answers in books while others are still taking a test.
All student problems need to go through the proper chain of command to resolve the situation.
VIII. POLICIES REGARDING STUDENTS A. Readmission to Program
1. Student must obtain a passing grade of 75 or above in all the academic and clinical courses of the program.
2. If a student leaves for extreme personal reasons, and has not exceeded the attendance policy absences, he/she will be given one opportunity for readmission that must be within the next academic year.
3. Any readmission is dependent upon available space in the program. B. Transfer Policy
The transfer of any student from one CTHSS Surgical Technology Program to another is subject to available space and synchronized curriculum. The student must be in good standing with academics, attendance, and clinical experience. Admission of candidate from another Surgical Technology Program not in the CTHSS system are required to apply for the program in the same manner as any other candidate applying for the program. We do not accept transfers from programs outside of the system. The admission requirements are: a) completion of an application, with transcripts and two letters of recommendation, b) the candidate must have a high school diploma or G.E.D, c) an up-to-date resume, d) pass a reading comprehension test and sit for an oral interview.
C. Request for Tuition Refund
Refer to the Connecticut Technical High School System. Full-Time Adult Student Information Form found in the Adult Education Application Packet as well as the PELL Grant Application packet.
D. Costs for the Program 1. Textbooks
Each student is required to purchase texts and supplies for use during the program. A list of required texts, supplies and sources of purchase will be given out to the accepted applicants at the orientation session.
2. Uniforms
All students will be required to purchase and wear the designated program scrub outfit starting on the first day of school. Students in violation of uniform dress will be sent home and will accrue missed time per attendance policy.
3. Transportation
Transportation is the responsibility of the student. Students, during their clinical externship may have to travel up to 60-90 minutes to get to their affiliating clinical site. 4. Insurance
a. Malpractice – Supplied by the State of Connecticut. b. Individual Health Insurance - Student’s responsibility. 5. Organizational Membership
a. Each student is encouraged to become a member of the Association of Surgical Technologist, which significantly reduces the cost of the national certification exam. b. Membership information will be provided by the instructors.
6. Parking Fees
Each student will be responsible for paying garage parking fees during their clinical rotations at their assigned hospitals.
7. National Certification Exam
Each student is required to pay for and take the National Certification Exam given by the National Board of Surgical Technologist and Surgical Assistant (NBSTSA) prior to or immediately after graduation at the school. The contact information for NBSTSA is as follows:
The National Board of Surgical Technology and Surgical Assisting 6 West Dry Creek Circle
Suite 100
Littleton, CO 80120 Toll Free: 800-707-0057 Fax: 303-325-2536 E. Vacations and Holidays
Vacations and holidays will be determined by the State Department of Education and the official school calendar.
F. Attendance
Regular attendance by students is a critical aspect of the educational process. Without daily classroom attendance, a student does not receive the benefit of personal interaction with his/her instructor and other students. Ideas are often exchanged which enrich the learning experience and research indicates that the mere make-up assignments and time cannot substitute for actual physical presence and involvement in the classroom. The educational objectives of the CTHSS attendance policy, as stated on page 15, play an integral role in developing a strong work ethic in the surgical technology student as they transition from surgical technology student to the surgical technologist profession.
Attendance will be utilized in reporting to Financial Aid and other training expense payment sources. It will also be utilized for inquiries made by potential employers.
At the start of each semester, all time absent, complete day out as well as time that a student arrives late (tardy) or leaves early, is considered absent time. Student will receive ‘notice of absence’ letters at three and five days of absence. Any missed time, over and above five days will result in a “Denial of Credit” letter.*Tardiness is defined as entering class after attendance has been taken. *Leaves early is defined as leaving the classroom or clinical site before the schedule end time of the academic or clinical day.
Please refer to the sections below entitled Attendance as a Course Requirement and Tardies/Early Dismissals for further details
.
Furthermore, in order to prepare students for the actual workplace, the Surgical Technology Program expects from its students what employers will expect and thus provides a smooth transition from classroom and clinical to the work force. The policies are designed to give the student a sense of responsibility and cooperation. Attendance will be utilized in reporting to Financial Aid and other training expense payment sources. It will also be utilized for inquiries made by potential employers.
G. Attendance as a Course Requirement:
The Surgical Technology program is divided into two terms for the purpose of attendance: 1. In order to earn credit for a course in the Surgical Technology Program in the
Connecticut Technical School, a student must not be absent more than ten days per year. Five days are allotted from August to December and five days are allotted from January to June. A letter of warning will be issues to the student on the third
4
day of absences as well as any subsequent absences during either term. Denial of course credit will take place on the sixth day of absence during either term.
If you are absent for any reason, you must call in prior to the start of the day whether it is an academic or clinical day. If the absence occurs on a class day, you are required to notify the Program DH prior to 7:30am. If unable to speak directly with the program DH then a message left on his/her answering machine is required. It is not acceptable to call one of your peers to relate the message to your DH. You must personally call in yourself.
2. If the absence occurs on a clinical day you are to notify the program DH as well as the clinical facilities contact person according to their specific directions. Failure to report an absence to the DH and/or the clinical facility will result in a written behavioral warning.
3. If an exam was scheduled, prior to absences, on the day you return to class you are expected to take the exam. If an exam was given on the day of your absence, it is to be made up on your first day back at school within a time frame designated by your instructor. Exams will cover the same material other students tested over, but may not be the same exam.
4. All clinical absences MUST be made up before graduation. More than five absences from clinical or academics each semester will result in course credit denial and is subject to attendance appeal.
5. Absence impacts your academics in the following manner: If an exam was scheduled, prior to absences, on the day you return to class you are expected to take the exam. If an exam was given on the day of your absence, it is to be made up on your first day back at school within a time frame designated by your instructor. Exams will cover the same material other students tested over, but may not be the same exam.
6. Denial of credit from the program based on attendance may be appealed by the student. A letter requesting an appeal must be submitted within three days of receipt of the credit denial letter. An appeals board meeting will be scheduled within ten days of the receipt of the request. During the appeal time, the student will remain in the program and must be present in class, all day, on time. 7. The student must be present at the meeting and must present documentation related
to proof of absence for one the following five reasons: 1. Medical reasons verified by a physician
2. Death in the immediate family (mother, father, husband, wife, son, daughter) 3. Religious holiday
4. School Suspension
5. Court appearance - positions are: Administrator, Student Support Staff Member and Dean of Students or Teacher.
8. The decision of the appeals board will be made known to the student. Should the appeal board recommend dismissal of the student, the student has the right to appeal to the Superintendent of the Connecticut Technical High School System. If a student is absent after being reinstated by the appeal board for any of the five reasons listed above, a written agreement will be developed between the student, the Program DH and Program Administrator. For all absences that do not fall into one of the above five reasons, the recommendations of the appeal board
will prevail.
H. Academic Tardy, Clinical Tardy and Early Dismissals
All time that a student is tardy or leaves early is unexcused absent time.*Tardiness is defined as entering class after attendance has been taken. *Leaves early is defined as leaving the classroom or clinical site before the schedule end time of the academic or clinical day. If a student is tardy or has early dismissal 3 times during the program, the student will receive a progressive discipline form. If the student fails to follow the written plan or is tardy or leaves early 3 additional times, they will receive a second discipline form and the administration of the program will be notified. The student will meet with administration to develop a plan of correction. If the student is tardy or leaves early an additional 3 times, they will be dismissed from the program. Any time and work missed due to tardiness or early dismissal must be made up within 5 school days with arrangements made with the Department Head.
I. Tardies
All time that a student is tardy or leaves early is unexcused absent time. As stated in the required attendance policy section:
If a student is tardy or leaves early 3 times during the program, the student will receive a progressive discipline form. If the student fails to follow the written plan or is tardy or leaves early 3 additional times, they will receive a second discipline form and the administration of the program will be notified. The student will meet with administration to develop a plan of correction. If the student is tardy or leaves early an additional 3 times, they will be dismissed from the program. Any time and work missed due to tardiness or early dismissal must be made up within 5 school days with arrangements made with the Department Head.
All absent time is added up. Student will receive ‘notice of absence’ letters at three and five days of absence. Any missed time, over and above five days will result in a “Denial of Credit” letter.
J. Evaluation of Student Performance
Evaluation is the method used to determine the extent to which a student is achieving the goals of a learning experience. It is an assessment of the growth of a student. There will be two types of evaluation, Academic and Clinical, used in the Surgical Technology Program.
A student must obtain a passing grade of 75 or higher in all academic and clinical courses of the program.
1.
Academic Evaluationa. Satisfactory evaluation is a grade of 75 or above. If an exam was scheduled, prior to absences, on the day you return to class, you are expected to take the exam. If a student is absent on the day of a test it must be taken on the day that they return to school. Tests not taken on the original date may be accessed a “10”-point penalty. Time of day for taking a test will be determined by the instructor. b. Academic Warning.
If a student is in jeopardy of failing stated academic objectives in a course, an Academic Warning Notice is issued. The instructor will arrange a meeting with the student to establish objectives and timelines for remediation. A signed copy of the Warning Notice will be placed in the student’s file. Three Warning Notices will result in course credit denial.
c. Cheating - If a student is caught cheating, the grade will be an automatic zero.
2.
Clinical Evaluationa. To successfully complete the clinical portion of the program, satisfactory performance related to each objective must be achieved. Students are required to complete a minimum of 120 cases during their clinical experience.
Surgical technology students must complete a minimum of 30 cases in General Surgery of which 20 need to be in the first scrub role. The remaining 10 cases can be in either the first or second scrub role.
Students need to complete a minimum of 90 specialty cases. They must have 60 cases in the first scrub role. Of the 60 cases, they must be first scrubbed on a minimum of 10 cases in the 4 different specialties. The additional 20 cases in the First Scrub Role may be distributed amongst any one surgical specialty or multiple surgical specialties. The remaining 30 cases can be in any specialty and either in the first or second scrub role.
b. Clinical Logs
1. Students are responsible for keeping a written record of every surgical procedure they scrub for during the clinical portion of the program. They are also required to keep a progressive tally of all cases.
2. Students are responsible for attaining a completed performance check list from their preceptors each day during clinical.
3. Instructors will visit each of the clinical facilities weekly for input from the Operating Room preceptors and to evaluate the student’s technique and practices during a surgical procedure.
4. Feedback from the Operating Room staff and observations from the instructors will be communicated to the individual students.
c. The clinical externship portion of the program is from January to June. The days of clinical are decided between the Program DH and the clinical facilities. The students will work eight hours during the clinical externship portion of the program. Their hours will be the same as the hours of the staff in the facility they are assigned.
d. Clinical Warnings
Students are responsible for monitoring their own academic and clinical progress and to seek appropriate assistance in areas identified as needing improvement.
1. A student not meeting the clinical objectives of the course will be given a clinical warning notice.
2. The instructor will arrange a meeting with the student to discuss the clinical warning. At this time mutually agreed upon objectives and timeline will be developed.
3. A signed copy of the Warning Notice and objectives will be placed in the student’s file.
4. Another meeting date will be scheduled for the purpose of determining how well the objectives and goals were attained.
5. Failure of the clinical rotation will result in course credit denial and dismissal from the program will be determined by:
a. Three written warnings at any period of time during the clinical rotation, or
b. Inability to maintain a 75 or better average during clinical or c. Misconduct at a clinical site that results in the clinical
administrative staff stating in writing that the student is not welcome to return to the clinical facility, or
d. The clinical facility may, at any time, for grave cause/clinical inabilities, require the Connecticut Technical School to withdraw any student from the clinical education course. A notice in writing requesting withdrawal of the student; noting the reason and effective date will be submitted.
e. Clinical failure will result in termination from the program and denial of course credit.
All dismissals from this program are subject to an appeal process. All appeals must be made in writing to Central Office through the subject area consultant. Appeals will be referred to the Assistant Superintendent for Adult Education.
A. Grading Policy
Grading is an essential part of the Surgical Technology Program. It is the means by which a student is able to gauge their progress in the program.
Objectives:
To provide a means to distinguish a system of grading for all subjects in the program. To provide the student the ability to distinguish their progress during the program.
To facilitate the faculties ability to gauge how well the students are progressing in the course.
Procedure:
a. Each test will be scored with a numerical grade. The grade will be entered in a grade book system called PowerSchool under the corresponding subject.
b. Subjects can be determined by utilizing the curriculum hour breakdown included at the end of this section.
c. Quizzes will be scored with a numerical grade. The grade will be entered into the grade book under the corresponding subject and weighed according to the grading guidelines stated in the syllabi for that subject. Homework will be corrected and scored with a numerical grade. Eight homework assignment grades in the same subject will be averaged and counted as a test grade for that subject.
d. Homework will be corrected and scored with a numerical grade. The grade will be entered into the grade book under the corresponding subject and weighted according to the grading guidelines stated in the syllabi for that course.
e. Students must maintain an average of 75 or better in each subject to remain in the program.
f. If the student is unable to attain and maintain a 75 or better in any subject, the student will be subject to the academic warning process (policy found in Section J, Evaluation of Student Performance pp. 91-92).
g. All makeup tests or quizzes MUST be completed on the day of return.
h. Classroom participation is critical to the learning process. As such, each student will take ownership of their education by actively contributing to class discussions on a daily basis.
i. All students will be required to pass a practical midterm at the end of the first term with a grade of 90 or better in order to attend clinical externship in the second term. If a student fails to attain a 90 on the first attempt then they will be provided with both remediation and the opportunity to retake the practical exam again. Each student is allowed two retakes on the practical midterm. On the third and final attempt for the practical midterm, a representative from CTHSS will be present to evaluate the student along with the two faculty members of the program. No student is allowed to advance to a clinical rotation site without mastery of the midterm practical.
j. Failure to attain a 90 or better on the clinical midterm after three attempts will result in the student’s dismissal from the program.
K. Homework Procedures:
a. All homework will be handed in on the assigned day and at the beginning of the class day.
b. In the event of an absence, it is the responsibility of the student to call the instructors at the end of the day to find out what their assignments are for the next day of class.
c. All assignments will be due on the day of return if there are no individual handouts from the instructors. If there is added paperwork given by the instructor, for a homework assignment, the individual student will be granted the same amount of time to complete the assignment as the other students in the class if they cannot make provisions to get the paperwork from a peer.
d. If the homework is not handed in on the assigned day, points will be deducted for the each day it is late.
1 day late = 10 points deduction 2 days late = 50 points deduction 3 days late = 0 for the assignment L. Dress Code
Classroom:
a. The standard dress for the Surgical Technology student is Navy Blue Scrubs both top and bottom. A short sleeve top is required in the classroom setting. No long sleeve tops are to be worn under the short sleeve scrub top. Warm-up jackets or sweaters are acceptable for warmth. No hats or hooded sweatshirts will be allowed to be worn during school hours. b. During classroom clinical time students will be required to wear safety glasses, short sleeve
scrub top, surgical hats and masks. Clinical:
Students will follow the Surgical Technology dress code policy as required by the Association of Surgical Technology (AST). Students must present themselves professionally and wear the proper PPE at all times in the clinical setting.
1. Hair should be clean and confined. 2. Minimal make-up.
3. No perfume/cologne. 4. Jewelry.
a. A single pair of stud earrings are the ONLY acceptable ear jewelry. The wearing of any other earring types are strictly prohibited in the clinical areas of learning (O.R. and Class Lab).
b. A watch and single ring, i.e. engagement, wedding band, ring of significance may be worn to the clinical setting but need to be removed prior to scrubbing.
c. No facial piercings allowed during the program. 5. Nail polish and artificial nails are not allowed.
6. Men should be clean shaven, however, if they are not clean shaven, they are required by the program
to wear a hood cap in the surgical area. 7. Clean scrub uniform.
8. Comfortable supportive shoes.
9. Socks /Stockings (no bare feet). No sandals or open toe shoes are allowed when in scrub attire. 10. Protective Eyewear (includes, goggles, face shields or masks with a CTEAChed shield) is mandated
for all surgical cases).
11. Hospital I. D. Badge if provided by hospital or school I. D. Badge.
12. Adhere to any specific dress code policies required by the clinical facility in which they are assigned.
M. Student Records
Refer to Full-time Adult Student Handbook. IX. PROGRAM EVALUATION
Evaluation of the program is done through a survey data collection system. The students are asked to fill out an evaluation form for the program and the clinical affiliates at the end of the school year.
A. The clinical affiliates are also given a program evaluation form at the end of the school year. They are also asked to complete an evaluation of the students that are hired by their organization within the following year of employment.
X. Organization of the Surgical Technology Program
The Surgical Technology Program is a two semester, full time day program. The first semester is comprised of six hours per day inclusive of academic theory and applied clinical practice. The second semester is comprised of 1 to 2 six hour days of academic theory and 3 to 4 days clinical externship to be completed at an assigned affiliated clinical facilities. The academic portion of the surgical technology program is structured to include the stated didactic and clinical requirements of the 6th edition of the AST Surgical Technology Core Curriculum. The AST surgical rotation clinical portion of the program, requires the surgical technology student to complete 120 surgical cases. Students are required to complete a minimum of 120 cases during their clinical experience. They must complete a minimum of 30 cases in General Surgery of which 20 need to be in the first scrub role. The remaining 10 cases can be in either the first or second scrub role. Students need to complete a minimum of 90 specialty cases. They must have 60 cases in the first scrub role. Of the 60 cases, they must be first scrubbed on a minimum of 10 cases in the 4 different specialties. The additional 20 cases in the First Scrub role may be distributed amongst any one surgical specialty or multiple surgical specialties. The remaining 30 cases can be in any specialty and either in the first or second scrub role.
The second scrub role cases may include a maximum number of 10 diagnostic endoscopy cases and 5 vaginal delivery cases. All surgical cases must be documented by their preceptors at the clinical facilities, but numbers in excess of the maximums listed above do not count towards the 120 required cases.
Surgical Technology Program Information
I have read and understand the attendance policy and recognize the consequences for failing to comply with it.
Print Name __________________________ Signature___________________________ Date_______ 10
NOTE:
The forms in this section must be completed and
returned to the Department Head or Instructor.
SIGN-UP/ACKNOWLEDGEMENTS/AGREEMENTS
11CONNECTICUT TECHNICAL HIGH SCHOOL SYSTEM
FULL-TIME ADULT STUDENT INFORMATION/FINANCIAL OBLIGATION
Program Resident/
Non-Resident
Tuition Registration Fees
(nonrefundable)
Payment Due Dates
New August 2015 Class Licensed Practical
Nurse
In-State Resident Total of $11,550
payable over three semesters ($3,850 per semester)
$50.00 Per program
Based on selected payment plan
New August 2015 Class Licensed Practical
Nurse
Non-State Resident Total of $23,772
payable over three semesters ($7,924 per semester)
$50.00 per program
Based on selected payment plan
Returning Aviation Resident Total of $6,576
payable over two years ($2,192 per installment) $50.00 per program August 2015 February 2016 New Aviation (December 2015) Resident Total of $6,576
payable over two years ($2,192 per installment) $50.00 Per program December 2015 **March 2016 **3rd Installment 2016-2017
Certified Nurse Assistant Not applicable $1,400
Per ten-week cohort
$50.00 per academic year
Date of first scheduled class
Dental Assistant Not applicable $3,710 payable over
two semesters ($1,855 per semester)
$50.00 per academic year
Date of first scheduled class Medical Assistant and Surgical Technology Not applicable $3,710 payable over two semesters ($1,855 per semester) $50.00 per academic year
Date of first scheduled class
Tuition and Fees:
The tuition and fee schedule for 2015-2016 academic year as approved by the Connecticut State Board of Education are as follows:
Acceptable Methods of Payment:
Bank check or money order made payable to Treasurer, State of Connecticut for the exact amount due;
Cash will be accepted in the school business office only during regular business hours (8:30 a.m. to 4:30 p.m.).
Unacceptable Methods of Payment: Personal checks;
Debit and credit cards;
Cash (except during normal business hours).
Other Financing Options (it is the responsibility of the student to initiate and follow-up on the methods listed below):
The CTHSS offers financing options including:
Tuition Waivers are available for veterans, students age 62 and over (subject to seat availability), and ONLY to students enrolled in the Certified Nurse Assistant program that are experiencing financial hardship;
Financial Aid: Students enrolled in a full-time program may apply for a federal Pell grant; Outside Agencies: Funding from other state agencies (i.e. Dept. of Labor, Office of the State
Comptroller);
G. I. Bill Veteran Education Benefits
** Any student failing to pay or be approved for an alternative financing option by the payment due date will be immediately dismissed from their program of study. As regular attendance is a critical aspect of the educational process, students with attendance problems may be dismissed from the program. **
Applying for a Tuition Waiver:
Bristol T.E.C. Programs
Automotive Technology; Culinary Arts; Electronics Technology; Heating, Ventilation and Air Conditioning; Manufacturing
Technology; Welding and Metal Fabrication; HVAC/R (2years)
Not applicable $3,710 payable over
two semesters ($1,855 per semester) $7,420 payable over four semesters ($1,855 per semester) $50.00 per academic year
$50.00
Date of first scheduled class
Date of first scheduled class each
Eligible students wishing to apply for a tuition waiver must complete a Tuition Waiver Request form (available at http://www.cttech.org/AdultED/index.htm) no later than four weeks prior to the first class session.
Veterans requesting a tuition waiver must attach a copy of their Certificate of Release or Discharge (DD Form 214) (90 days of honorable active duty service in addition to that spent in active duty training and in attendance at military service academies for any war period after August 2, 1990 or engaged in combat or in combat support role in specific conflicts prior to August 2, 1990);
Senior Citizens: Students age 62 and over requesting a waiver must attach a copy of their proof of age;
Students receiving educational assistance benefits under the G. I. Bill from the Veterans Administration must submit enrollment verification or training agreement. The student should provide the school Certification Officer, VA Form 22-1999 for submission to the Veterans Administration to receive the education benefits payment from VA;
If a student is denied tuition waiver, all tuition and fees are due by the next class session.
Applying for a Pell Grant:
Admitted students must complete the Free Application for Federal Student Aid (FAFSA). It is recommended that the student completes the FAFSA after completion and submission of the 2014 IRS Tax Return in order to avoid delay and having to go back to change information or making corrections. The completion and submission of 2014 IRS tax return will allow the student and/or parent(s) to use the IRS data retrieval tool when prompted during the FAFSA completion and will provide accurate financial information and therefore expedite the award process.
Admitted students must submit a valid Student Aid Report (SAR) and complete a CTHSS Financial Aid Application Packet available from the school’s Adult Education clerk;
The CTHSS deadline for applying for a Pell grant for the 2015-2016 academic year is as follows:
o LPN – July 22, 2015;
o All other full-time programs – August 3, 2015;
o New Aviation starting December 2015 – after official acceptance into the program by October 30, 2015;
*Applicants applying and accepted for a program after the specified deadlines can still apply for a Pell grant; however students will need to initiate tuition payments until determined eligible and Pell grant has been awarded.*
If a student is deemed ineligible for financial aid, outstanding tuition is due five days following receipt of the denial notification;
If a student is notified that their financial aid award will not cover the entire semester tuition cost, all tuition and fees are due five days following receipt of the award notice or by the regular tuition deadline, whichever is later;
The federal government randomly selects Pell grant applications for verification. If your application is selected for verification, you will be notified by the Financial Aid Administration and additional supporting documentation must be submitted by the specified deadline.
Procedures for Withdrawal:
In order to officially withdraw form an adult education program in the CTHSS and be considered for a tuition refund, candidates must complete and submit to the school’s Guidance Office, the following two documents available from the district’s Adult Education webpage www.cttech.org/AdultED:
11. Student Withdrawal Form
12. Request for Tuition Refund Form (Appendix IX)
Upon approval of the Student Withdrawal Form by a school administrator (principal or assistant principal), students may be eligible for a tuition refund.
Eligibility for Tuition Refunds:
Except for withdrawal due to military action or serious illness, if the Student Withdrawal Form is received from the student prior to the first scheduled class session, the student is eligible for a 100% tuition refund;
Except for withdrawal due to military action or serious illness. If the Student Withdrawal Form is received from the student after the first scheduled class session, but prior to the fourteenth (14th) calendar day from the first scheduled class session, the student is eligible for a 60% tuition refund;
Except for withdrawal due to military action or serious illness, if a Student Withdrawal Form is received after the fourteenth (14th) calendar day from the first scheduled class session, the student is not eligible for a tuition refund;
All requests for tuition refunds due to military action and supported by written documentation from the military are eligible for 100% tuition reimbursement;
All requests for tuition refunds due to serious illness and supported by written documentation from a medical professional are also eligible for 100% tuition reimbursement;
Except for military action or serious illness, no refunds will be provided to students who are dismissed from their program of study due to issues with attendance, unsatisfactory educational performance or violation of the district’s discipline policy as detailed in the 2015-2016 Full-time Adult Student Handbook.
Processing of Tuition Refunds (only for students tuition who had paid out-of-pocket. Pell Grant recipients will be processed through the Post-Withdrawal calculation to determine earned funds and refundable funds to the federal government):
If the student meets the eligibility requirements for a tuition refund, the Request for Tuition Refund Form (Appendix IX) completed by the student will be forwarded from the school administrator to the school’s business office and then to the State Department of Education’s (DOE) Payments Unit. The SDE Payments Unit will then issue a state invoice utilizing the State of Connecticut’s official accounting system (CORE-CT) and transmits the invoice to the State Comptroller for issuance of a refund check payable to the student within the state’s payment timelines (currently net 45 days).
I have read and understand the above:
_____________________________________ _________________________________ _______
Student Signature Print Name Date
CONNECTICUT STATE DEPARTMENT OF EDUCATION
Technical High School System
ADULT EDUCATION
Student Withdrawal Form
Last Name: _________________________ First Name: __________________ M. I. _________
Street Address: ___________________________ Apt. No. ________ P. O. Box _____________
Town: ______________________________________ State: ________ Zip Code: _________
School Name:__________________________ Shop: __________________________________
Reason for withdrawal:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Student signature: ______________________________________________ Date:_________
---
TO BE COMPLETED BY GUIDANCE STAFF
Official withdrawal code: _________________
Official withdrawal date: __________________
Guidance staff signature: ______________________________________ Date: ______________
Official grade at time of withdrawal: ___________________
Copies of the completed form must be sent to a School Administrator and to Central Office,
Attn: Financial Aid Administrator.
Withdrawal can be rescinded within a reasonable time.
Student Acknowledgement/Agreement
FULL-TIME ADULT STUDENT HANDBOOK
This form must be completed, detached from the handbook and submitted to your instructor to be filed in the student’s permanent record file.
Student Name (printed) _______________________________ Program Area ___________________ I HAVE READ, UNDERSTAND and WILL COMPLY WITH THE RULES AND REGULATIONS AS STATED IN THIS HANDBOOK:
STUDENT SIGNATURE ______________________________ ___ DATE ______________________ Discipline Policy and Substance Abuse Policy
I understand the responsibilities outlined in the Discipline Policy and Substance Abuse policy. I also understand that should I violate either policy I shall be subject to disciplinary action, up to or including expulsion from school and/or referral to law enforcement officials, for violation of the law.
Attendance Policy
I understand that regular attendance is the responsibility of the student and is a critical aspect of the educational process. I also understand the credit denial policy. I further understand that I may make a written request for review within three school days following receipt of notification of denial of credit. Education Records
Regarding education records, I understand that certain personally identifiable information is considered directory information and does not require a signed release for disclosure. I understand that unless I deny the release of any or all of this information within 10 school days of the date this student handbook was issued, directory information may be released. I also understand that I have a right to inspect and review all of my student records.
I acknowledge that I have reviewed the above.
________________________ _________________
Student Signature Date
Permission to Publish My Photographic or Video Image
I do hereby certify, acknowledge, authorize and give consent to the Connecticut Technical High School System (CTHSS) to publish my photographic or video image, at its discretion, in school newsletters, newspapers, in TV or video coverage or in any related printed, electronic and/or video publications. It is my understanding that my photographic or video image shall only be used for informational and publicity activities conducted by the CTHSS and shall not be used for any commercial purposes.
_________________________ __________________
Student Signature Date
Please sign below ONLY IF you DO NOT grant permission.
I do not grant permission for the release of directory information without my prior consent.
_____________________________ ____________
Student Signature Date
I do not grant permission for the use of photographic or video images of me to be used by the Connecticut Technical High School System.
_____________________________ _____________
Student Signature Date
Progressive Discipline Form
1st Offense “Cite Handbook” ________________________________________________________________________ Student Name ______________________________________________________________________________________ Student’s statement of incident (includes date, place)
______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Instructor’s statement of incident
_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Interventions _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Student Signature______________________________________ Instructor Signature __________________________________
****************************************************************************************** 2st Offense “Cite Handbook” ________________________________________________________________________________
Student Name ____________________________________ Date ______________ Referring Instructor ____________________
Student’s statement of incident (includes date, place)
_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Instructor’s statement of incident
_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Interventions _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Student Signature__________________________________________ DH Signature ____________________________________
****************************************************************************************** 3st Offense “Cite Handbook” ________________________________________________________________________________
Student Name ______________________________________ Date ______________ DH __________________________________
Student’s statement of incident (includes date, place)
_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Instructor’s statement of incident
_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Interventions _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Student Signature_______________________________________ DH Signature ________________________________________
AP Signature ____________________________________________Outcome ___________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
Student File