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Application & Information Packet Associate of Applied Science Degree in SURGICAL TECHNOLOGY Mail to: University of Arkansas - Fort Smith College of Health Sciences Advising Coordinator P O Box 3649 Fort Smith, Arkansas 72913-3649 Or Drop Off in Pendergraft Health Sciences Center, Office of the Dean

Application for Admission Associate of Applied Science Degree in Surgical Technology 1. Complete this application. (Type or print legibly) 2. If classes are in progress at another institution, please attach a schedule of those classes. Name Last First Middle Maiden Cell Phone# Home Phone# Work Phone# E-mail Address Mailing Address Student ID# Street Number or P O Box City State Zip Date of Birth *Have you ever been charged and/or convicted of a misdemeanor Yes No and/or felony? Yes No *Do you have any pending cases? Yes No If yes, identify your next court date. If this is a request for reentry, please supply the following information: 1. Date you left program, grade, and reason for leaving: 2. Work experience since leaving program: List all Colleges, Universities, or Other Schools Attended: Institution Dates Attended Hrs. Attempted GPA 1. 2. 3. * I understand that I shall not be considered for the program until I have been admitted to UAFS and submitted all required documentation. I understand that any notification of admission will be contingent upon a background check being accepted by all clinical agencies. Further, I understand acceptance is pending successful completion off all prerequisite courses. I understand and have read the Surgical Technology Program Statement. I, the below signed individual, hereby declare that to the best of my knowledge and ability, the information in this application is true and factual. I understand that false, misleading, or incomplete statements could lead to my subsequent dismissal or rejection as a surgical technology student. Student Signature Date July 2017

Associate of Applied Science Degree in Surgical Technology PROGRAM STATEMENT The Surgical Technology Program is a part of the College of Health Sciences (CHS) at the University of Arkansas - Fort Smith (UAFS). The Surgical Technology Program is accredited by the Accreditation Review Council on Education in Surgical Technology and Surgical Assisting (ARC/STSA) a CAAHEP Recognized Committee on Accreditation and sponsored by the American College of Surgeons. Students desiring admission to the Surgical Technology Program need to be aware of and understand the following information related to admission, progression, and graduation. Admission Criteria ADMISSION To be considered for admission to the program, students must meet the following criteria: 1) Complete university admission requirements to include submission of official transcripts from all colleges/universities attended 2) Have a minimum 2.00 cumulative grade point average (GPA) for all college course work (including transfer work and excluding developmental courses) and be in good academic standing 3) Complete required prerequisite courses for the program with a minimum grade of C or higher in each course prior to fall entry; prerequisite courses are the first two semesters as listed on the degree plan for a total of 28 hours 4) Take the Psychological Services Bureau (PSB) Health Occupations Aptitude Examination *For more information about testing, go to http://admissions.uafs.edu/testing-center/testing-center. Application Admission into the Surgical Technology Program is competitive. Students who meet the minimum criteria identified above are eligible to submit an application for admission. 1) Application Deadline - April 15 for fall entry into the program 2) Eligible students must submit an application for admission to the Advising Coordinator for the College of Health Sciences prior to the application deadline Selection Selection is based on the following weighted system: Phase One Quality Points earned for prerequisites courses on the Surgical Technology degree plan (college credit earned through CLEP or AP for a course will not be used for ranking purposes.) 40% Score earned on the PSB Exam 30% Cumulative GPA 30% NOTE: In the event that applicants have identical ranking scores, priority will be given to the student with the highest cumulative GPA. The top 25 applicants after Phase One of the selection process will proceed to Phase Two. Phase Two Interview NOTE: Following the completion of Phase Two, the top applicants will be offered positions for the available seats in the Surgical Technology Program. Meeting the minimum criteria for admission or taking courses on the Surgical Technology degree plan does not guarantee admission into the program. Students not admitted must reapply to be considered for another semester. Students identified as alternates are not guaranteed a position in the next class.

Additional Documentation Students admitted into the Surgical Technology Program must submit the following additional documentation prior to fall entry: Health Care Provider Statement/Medical Release form Proof of immunizations CPR Certification: American Heart Association Basic Life Support for Healthcare Providers (BLS) Criminal Background Check Drug Screen Note: Many clinical facilities require a criminal background check and/or drug screen on CHS students and have the authority to deny clinical training in their facility, secondary to outcome of either screening. Students unable to practice in any clinical agency because of an adverse or negative background check will be unable to complete the program objectives, thereby revoking admission into a program or halting continued progression in the student s program of study. PROGRESSION Science courses taken more than five years prior to entering the program will be evaluated on an individual basis by the Executive Director of the Surgical Technology Program and the Dean of the College of Health Sciences. See your advisor for more information and to request a science course evaluation. The Surgical Technology Program is competency based. To continue in the program, a student must maintain a 75 percent average in clinical performance and a 75 percent average through each didactic course. A student dropped for academic or any other reason may apply for readmission if in compliance with the UAFS Student Academic Progress Policy as outlined in the course catalog. A student who discontinues the surgical technology sequence for academic or any other reason must petition for readmission to the Surgical Technology Program. The readmission requirements are found in the Surgical Technology Program Policy and Procedure Manual (see the Readmission Criteria & Procedure Policy). The student is not guaranteed a position for readmission. A student who is readmitted is accountable for the degree requirements in effect at the time of readmission. A grade of C or better is required in ALL courses applicable to the Associate of Applied Science degree in Surgical Technology. GRADUATION To earn a Surgical Technology degree, a student must earn a grade of C or better in all required courses applicable to the Surgical Technology Program; earn a minimum of 2.00 cumulative GPA in all course work required for the major; and earn a minimum of a 2.00 cumulative GPA on all work attempted at the University. The student must meet with the Advising Coordinator for the College of Health Sciences to complete the graduation application one year prior to intended graduation. Per the ARC/STSA, the student must sit for the national certification examination to become a Certified Surgical Technologist (CST) prior to graduation. I have read and understand this program statement. Student Signature Date Note: Information is subject to change. Please check for current information before applying to the program. May 8, 2017

SURGICAL TECHNOLOGY PROGRAM Frequently Asked Questions Q. How do I get into the Surgical Technology Program? A. Submit an application and all supporting documentation prior to the April 15 deadline to the Advising Coordinator for the College of Health Sciences. Q. When may I enter the Surgical Technology Program? A. Each year one class is admitted in April that begins in the fall semester. Q. Are there any prerequisite courses to be taken before entering the program? A. Yes, some of the courses are general education courses required for an associate degree in Arkansas. A good foundation in all these subjects is essential for success in the Surgical Technology Program. The first two semesters listed on the degree plan are prerequisite courses and must be completed before entry in the fall semester. Q. How are applicants selected? A. The selection process is based on a weighted scoring system using the PSB examination, quality points earned for prescribed coursework, personal interview, and cumulative grade point average. Q. May I attend the program on a part-time basis? A. No, upon acceptance into the program it takes one year of full-time attendance to complete. Q. What career opportunities are available? A. Private Technologists for Surgeons Main Operating Rooms in Acute Care Hospitals Ambulatory Surgery Suites Traveling Surgical Technologists Organ and Tissue Procurement Technician Materials/Equipment Manager Central Service Manager Veterinarian Surgical Assistant Medical Sales Representative Physician Offices Most surgical technologists are employed in hospitals and adjacent outpatient surgery centers. Positions are also open in physicians clinics, free-standing surgery centers, veterinary clinics, as a traveling technologist, and as a private physician s assistant. Q. How is the job market? A. Salaries and benefits vary according to experience, ability, and geographic location. Recent surveys reveal a predicted need for 25% more surgical technologists by the year 2018. Q. What are the costs of the program? A. Estimated cost for the 2017-2018 school year is $16,850 for in-state residents (includes AR, OK, MO, TN, MS, LA, TX) and $34,532 for out-of-state residents. Costs may change without notice, other fees may apply, and additional costs may be incurred throughout the program s entirety. See the Surgical Technology web page for more details. UAFS Advising Center (479) 788-7400 College of Health Sciences Advising Coordinator (479) 788-7841 Updated: July 2017

Surgical Technology Program Admission, Selection, and Progression Chart PRE-ADMISSION 1) Students are admitted to UAFS through the Office of Admissions and School Relations 2) Students are advised by the Advisement Center until accepted into the College of Health Sciences Surgical Technology Program ADMISSION CRITERIA 1) Complete university admission requirements to include submission of official transcripts from all college/universities attended 2) Have a minimum 2.50 cumulative GPA for all college course work (including transfer work and excluding developmental courses) and be in good academic standing 3) Complete required prerequisite courses for the Surgical Technology Program with a minimum grade of C or higher in each course prior to fall entry; prerequisite courses are the first two semesters as listed on the degree plan for a total of 28 hours 5) Take the PSB Health Occupations Aptitude Exam ESTIMATED COST OF ATTENDANCE In State $ 22,711 Out-of-State $ 45,403 PRESCRIBED COURSES (116 points possible) BIOL 1153/1151 Biological Science/Lab MATH 1403 College Algebra BIOL 2203/2201 Human Anatomy/Lab BIOL 1463/1461 Microbiology & Immunology/Lab ENGL 1203 Composition I ENGL 1213 Composition II HLTH 1473 Medical Terminology PSYC 1163 General Psychology ITA 1051 Computer-Word Processing Science courses taken more than five years prior to entering the program will be evaluated on an individual basis by the Executive Director and the Dean. See your advisor for more information and to request a science course evaluation. PSB PRE-ENTRANCE EXAM (380 points possible) May be taken once per year Scores are valid for two years The most recent score will be used for ranking purposes ADMISSIONS PROCESS TO APPLY: Students must meet ALL admission requirements After taking the PSB and prior to the application deadline, students will submit an application to the Advising Coordinator. Application deadline: April 15 th Admission is highly competitive Selection is based on the following weighted system: Phase One 30% Score earned on the PSB Exam 40% Quality Points 30% Cumulative GPA Applicants ranked in the top 25 after Phase One will proceed to Phase Two. In the event of identical scores, preferences will be given to the student with the highest cumulative GPA. Phase Two The Personal Interview Following the completion of Phase Two, the top applicants will be offered a position for the available seats in the Surgical Technology Program. ACCEPTANCE Upon acceptance into the program, students must submit the following additional documentation: 1) Health Care Provider Statement / Medical Release Form 2) Proof of current immunizations 3) CPR certification: American Heart Association Basic Life Support for the Healthcare Provider (BLS) 4) Criminal Background Check 5) Drug Screen PROGRESSION To continue in the program, a student must maintain satisfactory clinical performance and a 75% average through each didactic course A student dropped for academic or any other reason may apply for readmission if in compliance with the UA Fort Smith Student Academic Progress Policy. A student who discontinues the sequence for academic or any other reason must petition for readmission to the Radiography program. The student is not guaranteed a position for readmission. A student who is readmitted is accountable for the degree requirements in effect at the time of readmission. A grade of C or better is required in all courses applicable to the AAS in Radiography SURGICAL TECHNOLOGY courses must be taken in the following sequence: FALL SEMESTER: SURG 1526 Surgical Technology Procedures I SURG 153A Surgical Technology Practicum I SPRING SEMESTER: SURG 1546 Surgical Technology Procedures II SURG 155A Surgical Technology Practicum II GRADUATION A Student must earn a grade of C or better in all required courses applicable to the Surgical Technology Program; earn a minimum of 2.00 cumulative GPA in all course work required for the major; and earn a minimum or a 2.00 cumulative GPA on all work attempted at the University. See the Advising Coordinator to submit an application for graduation one year prior to graduation. LICENSURE After being granted the Associate of Applied Science degree in Surgical Technology, the student is eligible to sit for the national certification examination to become a Certified Surgical Technology (CST). Updated: 07/2017