Surgical Technology Application Spring 2022

1. HACC Surgical Technology Clinical Program Application

By completing this form you are applying for the Spring 2022 Surgical Technology clinical program. If you have any questions regarding your application, please contact Professor Simms - emsimms@hacc.edu prior to the application deadline.

Fall semester courses will be included in point calculation.

ALL QUESTIONS MUST BE ANSWERED.

Question Title

* 1. Please enter your information here. PLEASE LIST YOUR HAWKMAIL email address. If you haven't activated it yet, do that NOW.

First Name: *

Last Name: *

Address: *

Address 2:

City/Town: *

State: *

Zip: *

PLEASE NOTE - WE USE HAWKMail only (ends in @hawkmail.hacc.edu) *

Phone: *

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* 2. What is your HACC ID? (Starts with H)

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* 3. Have you met (had a one-on-one advising appointment) with Emily Simms, the Surgical Technology Program Director, or Michelle Bucks?

I met with Emily Simms

I met with Michelle Bucks

I have not met with either

Comment

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* 4. Have you attended a mandatory information session during the past year?

Yes

Date of Information Session Attended

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* 5. Application history

This is my first application to the surg tech program

I applied to the surg tech program previously

If you applied previously, please list year of application and, if applicable, previous name

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* 6. Have you ever been in another health career clinical program at HACC?

Yes

If yes, what program? Did you graduate?

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* 7. Previous Education. Do you have an associate degree or higher from a regionally accredited college? Official transcripts must be on file in the Records Office to receive points.

Yes

Please list degree, school

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* 8. Do you have surgical services work experience (includes Sterile Processing Department (SPD), OB Tech, and OR Assistant)?

Provide a letter from employer (supervisor or HR) signed and on letterhead to EMSIMMS@hacc.edu prior to the application deadline - October 29 - in order to receive points.

Yes, I have surgical services experience

No, I do not have surgical services experience

Please briefly describe - list employer and job title

If I am selected for (and accept) a clinical seat I grant permission to the college to change my major to Surgical Technology 3646.

When you click "DONE" you will either see a "Thank you for applying" screen (which indicates successful application), or you will remain on this screen and see a message indicating "This question requires an answer" for any question not answered. Continue to answer all questions and click "DONE" until you see the "Thank You" screen. You should also be re-directed to a HACC clinical application confirmation webpage with more information. If you have any questions, email emsimms@hacc.edu prior to the application deadline. You should receive a confirmation email in a few business days to confirm that your application has been processed.

Question Title

* 1. Please enter your information here. PLEASE LIST YOUR HAWKMAIL email address. If you haven't activated it yet, do that NOW.

Question Title

* 2. What is your HACC ID? (Starts with H)

Question Title

* 3. Have you met (had a one-on-one advising appointment) with Emily Simms, the Surgical Technology Program Director, or Michelle Bucks?

Question Title

* 4. Have you attended a mandatory information session during the past year?

Question Title

* 5. Application history

Question Title

* 6. Have you ever been in another health career clinical program at HACC?

Question Title

* 7. Previous Education. Do you have an associate degree or higher from a regionally accredited college? Official transcripts must be on file in the Records Office to receive points.

Question Title

* 8. Do you have surgical services work experience (includes Sterile Processing Department (SPD), OB Tech, and OR Assistant)? Provide a letter from employer (supervisor or HR) signed and on letterhead to EMSIMMS@hacc.edu prior to the application deadline - October 29 - in order to receive points.

* 8. Do you have surgical services work experience (includes Sterile Processing Department (SPD), OB Tech, and OR Assistant)?

Provide a letter from employer (supervisor or HR) signed and on letterhead to EMSIMMS@hacc.edu prior to the application deadline - October 29 - in order to receive points.