Surgical Technology

Program Application Applications Available: Rolling Admissions

ADMISSION REQUIREMENTS

To become a candidate for selection to the Surgical Technology Program, please complete and return the attached application by email to vbardhi@aacc.edu or mail application to:

Anne Arundel Community College ATTN: School of Health Sciences, FLRS 112

101 College Parkway Arnold, MD 21012

Students will be admitted to the surgical technology course sequence on a rolling admission basis. The program will begin each spring term. Students will apply for the program only after meeting all academic and admission criteria. Incomplete applications will be returned to the student and can be resubmitted once they are complete. Students will receive an email sent to their AACC email account regarding placement if qualified. Students need only apply once to the program, providing their application is complete. A future seat will be slotted for them once the student meets the criteria for admission.

To be considered for conditional acceptance, the applicant must meet the following criteria:

• First consideration will be given to candidates whose resident address is in Anne Arundel County for at least three months prior to the date the application is submitted. The Address Verification form and supporting documentation must be submitted with the application via email to vbardhi@aacc.edu. Out-of-county applicants will be reviewed if space is available.

• Attendance at a mandatory information session. You may call 410-777-7310 for dates and times or visit https://www.aacc.edu/apply-and-register/credit-application/health-science-applicants/.

• During summer and fall 2020 semesters, real-time virtual information sessions will be considered face-to-face. • Must satisfactorily complete all academic and admission requirements. • Must have a minimum adjusted grade point average (GPA) of 2.0 at this college. • Prerequisites and chemistry requirement must be complete with a C or better by the date the application is

submitted. • Official transcripts, if applicable. Official transcripts are to be received by AACC Records and Registration office in

the sending institution’s original sealed envelope or through acceptable electronic method. Visit https://www.aacc.edu/apply-and-register/credit-application/apply/transfer-credit-to-aacc/ for details. Transcripts must be on file in the Records Office prior to making application or attached to the application at time of submission.

• Final acceptance in the program shall be contingent upon satisfactory completion of a criminal background check and health examination record and submission of a copy of the required CPR card by the stipulated deadlines.

Upon receipt of the application, students will receive an email sent to their AACC email account regarding the status of their application.

Eligible applicants will receive a selection packet assigning them to one of the following categories:

o Conditional Acceptance: Applicants who have met the academic and admission requirements and have been selected into the program are given conditional acceptance. Students who are granted conditional acceptance must submit a criminal background check, health examination record and current American Heart Association Basic Life Support (BLS) CPR certification by designated deadlines. Students who do not meet deadlines will not be further considered for admission.

o Waitlist: In the event there are more qualified applicants than seats available, qualified applicants not initially selected for conditional acceptance will be placed on a list in rank order and notified for selection when a seat becomes available. If applicant declines the seat, they will need to reapply for a future seat in the program.

Note: Any applicant having a change of mailing address, email address, or telephone number during the application process must notify the Admissions Office by email at vbardhi@aacc.edu.

IMPORTANT INFORMATION

1. Direct all inquiries regarding the application process to Valerie Bardhi via email at vbardhi@aacc.edu.

2. All Health Sciences students who are offered admission and/or clinical placement will be required to submit a complete criminal background check and urine drug screen. All student applicants’ final acceptance in the program shall be contingent upon satisfactory completion of a criminal background check and of a urine drug screen.*

All letters of acceptance shall state that the acceptance is conditional and contingent on submission of a criminal background check and urine drug screen–as may be required by the program–that results in satisfactory reports. If an accepted student tests positive for an illegal or un-prescribed drug, the student shall be denied admission or terminated from any Health Sciences program.

Separate, additional criminal background checks and urine drug screens may be required by clinical sites prior to placements. Students with an unsuccessful background check or urine screening who are denied by a clinical site that is required to meet program competencies shall be dismissed from the program and their registrations shall be withdrawn from courses related to the program of study. If the student tests positive for an illegal or un- prescribed drug, the student shall be denied admission or terminated from any Health Sciences program even if a denied placement was not required to meet program competencies. Successful reports of criminal background checks and urine drug screens do not assure eligibility for specific clinical site placement, program completion, and/or eligibility to sit for professional licensure/board examinations.

Students are reminded that licensing boards for certain health care occupations and professions may deny, suspend, or revoke a license or may deny the individual the opportunity to sit for an examination even if the individual has completed all program course work if it is determined that an applicant has a criminal history or has been convicted of, or pleads guilty, or pleads nolo contendere or the like to a felony or other serious crime.

Successful completion of a Health Sciences program of study at Anne Arundel Community College does not guarantee licensure, the opportunity to sit for a licensure examination, certification or employment in the relevant health care occupation.

Students may be automatically denied admission or, if enrolled, dismissed from the program if they have not been truthful or have provided inaccurate information on the application or on any other form or submission. Students who have questions or concerns are encouraged to contact the Health Sciences Admissions Office at healthsciencesadmissions@aacc.edu.

* Notwithstanding the statements herein regarding urine drug screens, as of September 2010, only certain programs will be requiring drug screening. AACC shall inform students which programs presently require them. However, AACC, at any time, has the right, upon notice, to require any and all students and any and all programs to comply with drug screening.

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SURGICAL TECHNOLOGY PROGRAM APPLICATION

Applications are accepted for the Surgical Technology Program on a rolling admission basis for program selection. The program will begin each spring term. Students need only apply once to the program, providing their application is complete. A future seat will be slotted once the applicant meets the criteria for admission.

If you have previously submitted your official transcript(s) to Records and Registration at AACC, it is your responsibility to ensure that the transcript(s) have been posted by the time you submit your application. Transcripts are considered official only when received by Anne Arundel Community College in the sending institution’s original sealed envelope or through acceptable electronic method. If the official transcript(s) are not posted, the application will be considered incomplete and will be returned.

Transcript(s) being submitted to AACC for the first time must be in the sending institution’s original sealed envelope and attached to this application. Students are responsible for making sure official transcripts have been received by the college if previously submitted. You will be notified by the Records Office of any courses that do not transfer as equivalent to coursework at AACC.

Submit completed application to vbardhi@aacc.edu or via mail to Anne Arundel Community College, ATTN: School of Health Sciences, FLRS 112, 101 College Parkway, Arnold, MD 21012.

DEMOGRAPHIC INFORMATION (Please Print) Last Name First Name Middle

Address

City State Zip Code County

Last 4 digits of social security # College ID #

The mailing address you provide on this application will be your address of record. It is your responsibility to notify the Health Sciences Office as well as the Records Office of name, address and phone number changes during the application process. Applicants are advised to check their AACC email account periodically for placement updates and notices.

Home Phone Cell Phone Work Phone

AACC Email Address – Required No other email is acceptable

@mymail.aacc.edu

By signing below, I agree/understand the following:

1. I attended a mandatory Surgical Technology information session on (date). 2. I have an active admission status at AACC and am in Good Standing (2.0 GPA>) with the college.3. My AACC email address is required for correspondence with AACC.4. I have submitted final official transcripts* from ALL previously attended colleges. International

students must submit official transcript evaluation report from ECE, WES or SpanTran toverify/authenticate your high school and/or college transcripts.

5. I have submitted an official transcript* to verify graduation from either high school/GED or date collegedegree conferred if appropriate.

6. If information is missing from my application or file (including transcripts), it will NOT be processed and willbe returned to me. Incomplete applications will NOT be considered.

7. I understand that by filling in my name below, it will be considered my signature.

*Transcripts are considered official only when received by Anne Arundel Community College in the sendinginstitution’s original sealed envelope or by acceptable electronic submission.

SIGNATURE: Date: PREREQUISITE REQUIREMENTS

Must be completed with a grade of C or better by time of application submission. Due to the selection process, the Surgical Technology program cannot accept

Pass/Fail as a replacement for letter grades in the required courses. SURGICAL TECHNOLOGY

PREREQUISITE GRADE CREDITS EARNED AT COLLEGE/UNIVERSITY

TERM & YEAR COMPLETED

BIO 231 Human Biology 1

and BIO 232 Human Biology 2

ORBIO 233 Anatomy and Physiology 1

and BIO 234 Anatomy and Physiology 2

MDA 113 Medical Terminology (MDA 100 is not acceptable)

CHEMISTRY Completed a chemistry course and earned a grade of C or better.

U.S. High School Chemistry (1 credit) or CHE 011 (2 equivalent hours) or CHE 103/111 (3-4 credits)

If completed in high school, you MUST submit a final official high school transcript.

If home schooled, the high school curriculum must be under a recognized umbrella organization with the supervision of a state-approved curriculum. AACC may require a course syllabus so that our chemistry department chair can review and approve the curriculum.

Chemistry requirement received from: GRADE: YEAR/SEMESTER:

INTERNATIONAL STUDENTS

Have you submitted an official transcript evaluation report from ECE, WES, or SpanTran to verify/authenticate your high school and/or college transcripts to the Records office prior to or with your program application?

Yes No

AGENCY USED:

GENERAL EDUCATION REQUIREMENTS All general education courses listed below must be completed with a C or better prior to graduation from the Surgical Technology Program. Due to the selection

process, the Surgical Technology program cannot accept Pass/Fail as a replacement for letter grades in the required courses.

*Courses must be completed by the end of the first year/term one of the program

COURSE (Grades must be C or better) GRADE CREDITS COLLEGE WHERE TAKEN

SEMESTER/YR COMPLETED or

CURRENTLY ENROLLED

*General Microbiology BIO 223(corequisite with SGT 100)

*General Education Math (From Catalog)

*ENG 101/ENG 101A

Previously completed ENG 111, 115 or 121 will be accepted.

*CTA 100 or CTP 103Previously CSI 112, CSI 113 & CTA 103 will be accepted.PSY 111

Arts & Humanities Course

Students enrolled in the Surgical Technology program must complete an Arts & Humanities course that satisfies the diversity requirement to qualify for graduation. If you have previously completed an Arts & Humanities (General Education Requirement) and/or diversity course you should consult with an academic advisor to make sure that you have met both requirements.

COURSE:

GRADE: _____________

CREDITS: ____________

INSTITUTION WHERE COMPLETED: __________________________________

SEMESTER/YEAR:

BACKGROUND INFORMATION

Submit explanation of questions for which you answer "yes" and provide documents relating to your answer in a sealed envelope and emailed to tdneall@aacc.edu or mailed separately to address on first page of this application, ATTN:

Tammie Neall. Do not write explanation(s) on the application.

Yes �

No �

Were you ever disciplined for any academic or behavior/conduct issue by any college, university, or any other educational institution after high school including, but not limited to, probation, dismissal, suspension, disqualification, or imposition of a failing grade as a disciplinary sanction? If your answer is yes provide a written explanation and all relevant documents relating thereto.

Yes �

No �

Have you ever been convicted of a crime, driving while intoxicated or impaired (either by alcohol or drugs), had your driving privileges suspended or revoked, and/or are there any pending charges regarding any of the above? If your answer is yes provide a written explanation and all relevant documents relating thereto.

Yes �

No �

Have you ever surrendered your driver's license or had such license suspended or revoked? If your answer is yes provide a written explanation and all relevant documents relating thereto.

Yes �

No �

Have you ever surrendered a professional license, certification or registration, or had one restricted, suspended or revoked? If your answer is yes provide a written explanation and all relevant documents relating thereto.

Yes �

No �

Have you ever been placed on professional probation, had conditions or limitations placed on your ability to work even if your license had not been restricted, suspended or revoked? If your answer is yes provide a written explanation and all relevant documents relating thereto.

Yes �

No �

Have you ever had your clinical privileges at any office or facility restricted, suspended or revoked? If your answer is yes provide a written explanation and all relevant documents relating thereto.

NOTE: Licensing boards for certain health care occupations may deny, suspend, or revoke a license or may deny the individual the opportunity to sit for an examination even if the individual has completed all program course work, if it is determined that an applicant has a criminal history or is convicted or pleads guilty or nolo contendere to a felony or other serious crime.

I certify that the information on this application is true and accurate to the best of my knowledge. Falsification or misrepresentation of any information on this application may result in being denied admission, or if enrolled, dismissed from this program. I understand that final acceptance into the Surgical Technology Program shall be contingent upon satisfactory completion of a criminal background check and satisfactory completion of a health examination record.

I understand that by filling in my name below, it will be considered my signature.

Signature: Date:

Print Name:

Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410- 777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or Maryland Relay 711.

Please review prior to submitting this application. This application must be completed in its entirety.

The Address Verification Form is part of the application packet and must be completed in its entirety and submitted with the application. Be certain to include two (2) forms of supporting documentation as stipulated on the form.

Questions pertaining to this form should be addressed to Melissa Mumma in the Records Office at 410-777-2721 or mamumma@aacc.edu.

Out-of-county applicants will be reviewed only if space is available.

June 2020

Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410- 777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or Maryland Relay 711.

ADDRESS VERIFICATION

101 College Parkway, Arnold, Maryland 21012-1895 410-777-2243

ADDRESS VERIFICATION FOR HEALTH SCIENCE PROGRAM APPLICANTS Directions: This form must be completed entirely and supporting documents submitted as part of the health sciences program application process. Applications submitted without this document will be returned as incomplete.

If you the student support yourself, provide a minimum of two of the documents listed below in your name, at current resident address that are dated three months prior to the application deadline date.

OR If for the most recent 12 months, you, the student, have resided in Anne Arundel County, but are supported by someone in another Maryland county or state, provide a minimum of two of the documents listed below in your name, at current resident address that are dated three months prior to the application deadline date.

OR If for the most recent 12 months, another person(s) has provided one-half or more of your financial support, provide a minimum of two documents listed below in your supporter’s name, showing current resident addresses that are dated three months prior to the application deadline date. In addition, you will need to provide one document from the list below in your name showing current resident address and dated three months prior to the application deadline date in addition to the two documents from your supporter. The supporter must also complete the information requested in Section B. Military Personnel Only: Complete this form with a copy of your military ID (also dependent ID, if spouse or dependent), copy of orders, and a copy of housing assignment, lease, deed or utility bill showing your resident address. Example: All documents must be dated three months prior to application submission date.

Acceptable Documents • Maryland Driver’s License• Voter Registration Card• Copy of Deed of Trust or Signed Lease• Maryland Withholding Form – MW 507 (Not U.S. W-2)• Maryland Income Tax Return (not U.S.)• Utility Bill including gas, electric, water, phone, cable, etc.• Vehicle Registration Card

The college reserves the right to request additional information and documentation as necessary.SECTION A – TO BE COMPLETED BY STUDENT

Student Name Student ID or SSN (last 4 digits)

Resident Address

City State Zip

County Day Phone Evening

Dates of Occupancy at above address Own Rent

Previous Address

City State Zip

How long did you live at this previous address?

Are you registered to vote? Yes No County State

Do you possess a valid driver’s license? Yes No

If yes, what state issued? County Date of Issuance

OFFICE USE ONLY Program and Term:

Surgical Technician - FA20

Do you own a motor vehicle? Yes No

If yes, in what state issued? County Date of Issuance

Do you have the use of another person’s motor vehicle? Yes No

If yes, provide name Relationship to student

Are you paying Maryland income tax for this year on all earned income? Yes No

If yes, what county? List where you have filed tax returns for the past two (2) years: Year State County

Year State County

If employed, is Maryland income tax currently being withheld? Yes No

If yes, what county? For the most recent 12 months, has another person(s) provided one-half or more of your financial support? *Yes No*If the answer to the above question is “Yes”, SECTION B of this form must be completed by your supporter.

Additional Information

The college reserves the right to request additional information and documentation as necessary.

I CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF MY KNOWLEDGE.

Signature of Student (required) Date

OFFICE USE ONLY ACCEPTABLE DOCUMENTS: MILITARY/BRAC WAIVER:____ MD driver’s license ____ Military ID (& Dependent ID if spouse or dependent)____ MD income tax return (not U.S.) ____ Copy of Orders____ Voter Registration Card ____ Copy of housing assignment, lease, deed or utility bill____ Vehicle registration showing resident address ____ Utility bill showing home address ____ Copy of deed of trust or signed lease ____ MD withholding form – MW 507 (not U.S. W-2)

STATUS OF RESIDENT ADDRESS Anne Arundel County Other MD county Out-of-State Term & Year

Authorized signature: Date:

SECTION B TO BE COMPLETED BY SUPPORTER IF YOU ANSWERED “YES” to the following question:

For the most recent 12 months, has another person(s) provided one-half or more of your financial support?

Name of supporter Relationship to student

Supporters Address

City State Zip

County Day Phone Evening

Date of Occupancy at above address Own Rent

Previous Address

City State Zip

How long did you live at this previous address?

Are you registered to vote? Yes No County

Do you possess a valid driver’s license? Yes No

If yes, in what state issued? County Date of Issuance

Do you own a motor vehicle? Yes No

If yes, in what state issued? County Date of Issuance

Do you have the use of another person’s motor vehicle? Yes No

If yes, provide name Relationship to student

Are you paying Maryland Income tax for this year on all earned income? Yes No

If yes, which county?

List where you have filed tax returns for the past two (2) years: Year State County

Year State County

If employed, is Maryland income tax currently being withheld? Yes No

If yes, in which county?

Additional information:

The college reserves the right to request additional information and documentation as necessary.

Signature of supporter: Date:

Notice of Nondiscrimination: AACC is an equal opportunity, affirmative action, Title IX, ADA Title 504 compliant institution. Call Disability Support Services, 410-777-2306 or Maryland Relay 711, 72 hours in advance to request most accommodations. Requests for sign language interpreters, alternative format books or assistive technology require 30 days’ notice. For information on AACC’s compliance and complaints concerning sexual assault, sexual misconduct, discrimination or harassment, contact the federal compliance officer and Title IX coordinator at 410-777-1239, complianceofficer@aacc.edu or Maryland Relay 711.

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