SURGICAL TECHNOLOGY PROGRAM APPLICATION
Dear Applicant:
Thank you for your interest in Wharton County Junior College’s Surgical Technology Program. Information on the program and the requirements necessary to apply for admission to the program are in this packet.
The Surgical Technology Program is a one-year program that begins in August of each year. In order to apply and be considered for acceptance into the program the following items must be submitted by the last Thursday in May. Applications will continue to be accepted until a class is chosen.
• The Surgical Technology Application, Questionnaire, References and Technical Standards forms are to be filled out and returned to the Surgical Technology Department.
• The WCJC application is to be filled out and returned to the Registrars’ Office. A copy of the WCJC application should also be included with your application.
• High School transcript or GED.
• Original college transcript(s) from each college attended (if applicable) • Test Scores for one of the following: (ACT is preferred test)
ACT scores (18+ in Reading and 17+ on the Composite: ACT may be either National or Local THEA (Reading & Math 230, Writing 220)
ASSET (Reading 41, Math 38, Writing 40 & above minimum 5 or above on Essay, 39 minimum 6 above on Essay
COMPASS ( Reading 81+, Math 39+ and Writing 58 or less(essay score of 6+) OR Writing 59+ (essay score of 5+) No others will be accepted. Scores can be no older than 5 years. For more information on testing, contact the Testing Center at 1-800-561-9252 ext. 6386.
• Copy of current Driver’s License
• Three names and complete mailing and complete email addresses for references. Reference forms will be forwarded to the names provided. References must not be related to you.
• Hepatitis B series must be started by May 15th. The series takes six months to complete. Documentation of at least two (2) vaccines are required by the first day of class.
• Attend one information session prior to May deadline. The information sessions are scheduled for the second Monday of the month of January, February, March, April and May from 5:00-6:00 p.m. These sessions will be by appointment only. Please call 979-532-6491 for scheduling information sessions
The above information should be mailed to:
Wharton County Junior College Surgical Technology Department ATTN: Barbara Lee
911 Boling Highway Wharton, TX 77488
If you have any questions or need more information, please call (979) 532-6491 or 1-800-561-9252, ext. 6491. Sincerely,
WHARTON COUNTY JUNIOR COLLEGE
SURGICAL TECHNOLGY PROGRAM
INFORMATION FOR APPLICANTS
ACCEPTANCE
Informative interviews are scheduled with qualified applicants. Once we have interviewed all qualifying applicants, the class will be selected. For you to be eligible for acceptance your file must be complete. We are limited to 16 students. Application to the program does not guarantee acceptance.
CRIMINAL BACKGROUND CHECKS AND DRUG SCREENS
Most clinical facilities require that criminal background checks and drug screens be completed prior to allowing students to participate in clinical training at their facilities. Applicants conditionally accepted into the Surgical Technology Program will be required to complete a criminal background check and drug screen. Final acceptance into the program is contingent upon a satisfactory background check and drug screen, which will be completed by an approved agency. The cost of the criminal background check and the drug screen will be at the applicant’s expense. The estimated cost for the criminal background check is $53.58. The estimated cost of the drug screen is $50.00. Information regarding this process should be obtained from the Surgical Technology program.
POSITIVE DRUG SCREEN
An applicant with a positive drug screen will not gain acceptance into the program and will not be considered for admission in the future applicant pools.
UNIFORMS
Student uniforms are required. Information will be given to students during orientation.
PHYSICAL EXAMINATION and IMMUNIZATIONS
Due to Senate Bill 1177 effective September 1, 2012, the college must verify immunity by way of a titer for all healthcare students for the following: Varicella, Rubella, Rubeola, Mumps, and Hepatitis B. The student must also present an ADULT dose of TDap.
A physical examination by your physician with satisfactory results is required along with proof of immunizations prior to entry into the program. Final acceptance is contingent upon satisfactory results of your physical examination. The physical examination form will be mailed with acceptance letters. Proof of the following immunizations if required:
Tetanus/Diphtheria One dose within the last 10 years. MMR
Two doses required if born after 1956 or proof of serologic immunity. Dose 1 given at age 12-15 months; or later
Dose 2 given at age 4-6 years, or by age of 12 years; or at least one month after first dose. Hepatitis B Documentation of at least two vaccines is required by the first day of class. (if not already
immune). Series takes six months to complete; series must be started prior to May 15th to be completed.
COST
The approximate cost of the program is as follows:
Term Tuition Books Misc. Uniforms/Shoes Graduation
Fall See college catalog $900 $100 $150/$50
Spring See college catalog $350 $240 $50
Summer See college catalog $100 $50
WORK
Due to the full time nature of this program, outside employment is discouraged. If one has to work no more than 20 hours per week is recommended.
FINANCIAL AID
All financial aid is handled through the Financial Aid Office at the main campus in Wharton or the CentraPlex Campus in Sugar Land.
FBTC: (281) 239-1500 ■ Sugar Land: (281) 243-8401 Ext. 6345 ■ Wharton: (979) 532-4560 Ext. 6345 GRADES
A “C” average (75%) is required in each course to continue in the program. In some courses, a 75% TEST average is required.
ATTENDANCE
Only four (4) absences are allowed in fall and spring; three (3) absences in the summer. Three (3) tardies constitute one (1) absence.
HOURS
Class time is full time Monday - Friday. Clinicals will start in early January. CPR
Prior to class beginning, proof of American Heart Association Healthcare Provider CPR certification is
required. Classes are available throughout the community; WCJC’s EMS Department (979-532-6554), local hospitals, fire stations, American Heart Association, etc. (MUST be Healthcare Provider ONLY. Re-certification is required during the year if necessary to keep the certification current.
IT IS THE SOLE RESPONSIBILITY OF THE APPLICANT TO MAKE SURE THAT ALL REQUIRED
PAPERWORK IS SUBMITTED TO THE SURGICAL TECHNOLOGY PROGRAM BY THE
SURGICAL TECHNOLOGY PROGRAM APPLICATION
PRINT CLEARLY Date ____________________________
________________________________________________________
Name Last First MI SS#
Home Address
____________________________________________ ______________
City State Zip Code
( )______________________ ( ) _______________________ ( ) _________________________ Home Phone Cell Phone Alternate Phone Email Address _________________________________________ Date of Birth (optional) _____________________ Name, address, and telephone number of person to be notified in case of an emergency: ________
______ Do you have a High School Diploma or GED? Yes ____ No ____
Have you attended any Surgical Technology Program? Yes ____ No ____ If yes, name and address of Surgical Technology Program attended:
Reason for withdrawal: ________
Have you ever been convicted of a crime and or released from confinement following a conviction for any criminal offense? Arrests or charges that have been expunged need not be disclosed. Yes ____ No ____
If yes, give date, place and nature of each such conviction.
_ _
Are you presently charged with any violation of the law? Yes ____ No ____ If yes give date, place and nature of each such charge.
EMPLOYMENT: (Names and addresses of last three employers (including present) and dates of employment. Employers will not be contacted)
Name Address Dates of Employment
EDUCATION: List name and location of all schools attended, including high school.
Name Address Degree Earned/# Hrs.
Completed
REFERENCES
PLEASE GIVE US THE NAMES, COMPLETE MAILING ADDRESSES AND EMAIL ADDRESSES OF THREE (3) REFERENCES THAT ARE NOT RELATED TO YOU: (PLEASE PRINT CLEARLY)
_______________________________________________ Name (Mr., Mrs., Miss)
_______________________________________________ Address
_______________________________________________ City, State, Zip Code
______________________________________________ Email Address _______________________________________________ Name (Mr., Mrs., Miss) _______________________________________________ Address _______________________________________________ City, State, Zip Code
_______________________________________________ Email Address _______________________________________________ Name (Mr., Mrs., Miss) _______________________________________________ Address _______________________________________________ City, State, Zip Code
_______________________________________________ Email Address
______________________________________
_______________________
Applicant’s Name (PLEASE PRINTED CLEARLY) Phone #TECHNICAL STANDARDS
The following is a list of Technical Standards for all students enrolled in the Surgical Technology Program. These standards indicate the requirements necessary for a student to function as a student Surgical Technologist. A student must have the ability to perform all the requirements listed below:
1.
Visual acuity with corrective lenses to read very fine, small print on medication containers, physician’s orders, monitors, and equipment calibrations and small sutures.2.
Hearing ability with auditory aids to: understand the normal speaking voice without viewing the speaker’s face, hear monitor alarms, emergency signals, take/hear blood pressure, understand muffled voices due to surgical mask and respond appropriately.3.
Physical ability to stand for prolonged periods of time, perform cardiopulmonary resuscitation, lift patient and objects of 50 lbs. or more, and move from room-to-room or maneuver in limited spaces.4.
Communicate effectively in verbal and written form by speaking clearly and succinctly when explaining treatment procedure, describing patient conditions, and implementing health teaching. Write legibly and correctly in patient’s chart for legal documentation.5.
Manual dexterity to use sterile technique to insert catheter, pass surgical instruments appropriately, and set up using aseptic technique.6.
Function safely under stressful conditions with the ability to adapt to ever-changing environment inherent in clinical situations involving patient care.7.
Possess the intellectual ability and emotional stability to exercise independent judgment to properly care for the surgical patient and accurately utilize all resource material available to prepare for a surgical procedure. Accurately identify, calculate dosage, and transfer medications. Work calmly and efficiently in stressful situations and maintain calmness during emergency situations. Perform duties while exposed to communicable diseases, unpleasant sites, odors, and materials.8.
Environmental requirements and conditions for a Surgical Technologist involves risks and/or discomforts that require special safety precautions such as wearing gowns, caps, masks, gloves, and eye protection. Submit to periodic drug screening, and adhere to the policies of the externship facility attending.I have read and understand the Surgical Technology Technical Standards. By signing below, I verify that I have the ability to perform all these requirements.
QUESTIONNAIRE
Applicant’s name:
In a paragraph of not less than 50 words tell us your reason for wanting to enter into the Surgical Technology Program. Please write clearly and neatly.
List any asset you have that you think would be beneficial to Surgical Technology.
SURGICAL TECHNOLOGY PROGRAM CHECKLIST
It is the PROSPECTIVE STUDENT’S RESPONSIBILITY to make sure we have all the relevant documents in your file. If we do not have these items on or before the last Thursday in May, the applicant will not be considered for the program.
___ Application of Admission to the Surgical Technology Program ___ Questionnaire
___ Three References (names with complete mailing and email addresses) ___ Technical Standards
___ Copy of WCJC application
___ Copy of High School transcript or GED
___ Copy of College Transcript(s) from each college attended
___ Copy of ACT, THEA, ASSET, or Compass scores (ACT is preferred test) ___ Copy of Driver’s License
___ Must be at least 18 years of age
___ Hepatitis B series (Documentation of at least 2 vaccines by the first day of class) Series must be started prior to May 15th.
___ Attendance at Information Session prior to the application deadline __________________ (date) ___ All information turned in by the last Thursday in May
It would be helpful if all information is in the order as listed on this checklist and submitted all at once to: Wharton County Junior College
Surgical Technology Department ATTN: Barbara Lee
911 Boling Highway Wharton, TX 77488
