- Surgical Technology Application (.docx)
- Surgical Technology Application (.pdf)
Application Checklist
Student Name:
Acknowledgement of Completion:
Program application form
Community service form
Admission advisement certificate of attendance
Job shadow form
Criminal background check disclosure/consent form
Review and self-assessment of performance standards
BLS/AED certification achievement card
Health certification requirements:
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Immunizations:
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MMR immunizations 1 and 2 or rubella titer
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Rubeola immunization or titer
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Chicken pox – proof of having chicken pox or chicken pox immunization per authorized medical signature or varicella titer
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Influenza immunization
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Meningitis immunization
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TB skin test – 1 month prior to program start
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Hepatitis B vaccination (series of 3) Signed verification of Hepatitis B status or declination
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DTAP – Diphtheria, tetanus and pertussis immunization