Surgical Technology Acknowledgements Form

Surgical Technology
Please read each statement carefully. This document contains important information regarding your selected program of study, and expectations within the career field. Please initial each statement, acknowledging that you have read and understand what to expect within this career field.
I understand that this program is rigorous and requires extensive reading, dedicated study time and time management skills.
Initial
I understand it is recommended that students are not employed, or they work 20 hours or less while enrolled in this program.
Initial
I understand the program is a full-time, Monday through Friday, daytime program which requires approximately 40 hours per week to be devoted to my education.
Initial
I understand that the clinical environment can be stressful and I will be required to touch, move, and interact with patients. Additionally, I must be responsible and reliable, have good communication skills, like working with people and equipment, and have good physical stamina and a strong stomach.
Initial
I understand I will see and be exposed to blood and other bodily fluids.
Initial
I understand that I should have a good math and science background.
Initial
I understand the grading system is different and should I earn a final grade below 80 in any one course, I will not be eligible to continue in the program.
Initial
I understand a criminal background check, drug screen, health and liability insurance, and physical exam will be required for entry into the clinical facility for my program.
Initial
I understand I will be required to take the National CST exam after I graduate in order to be certified in my profession (NBSTSA Certification, as a CST is required for employment in the State of South Carolina).
Initial
I understand continuing education will be required once I am a professional in my field.
Initial
What can I expect during clinical and after graduation?
(Initial each statement)
- I understand that I will be exposed to various germs and viruses.
- I understand that I will be required to work various shifts and I may be on call. *
- I understand I will be a scrubbed, gowned, and gloved participant in surgery. *
Name

First NameMiddle NameLast Name
Student ID#
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature

STATEMENT OF UNDERSTANDING REQUIREMENT FOR BACKGROUND CHECKS, DRUG SCREENS, AND VACCINES.
Admission to the Health and Human Services programs does not guarantee acceptance into a clinical rotation at an affiliate health care facility, which is required for graduation. Affiliate clinical sites supporting Health and Human Services programs require that students have background checks, and drug screens, and a completed York Technical College Health Form prior to acceptance or placement in clinical rotations. Random and discretionary background be done at the checks and drug screens may also be conducted at the request of the clinical site. These checks will be at the expense of the student.

Results of background checks and drug screens, physical exams, immunization records, titers, and 2-step PPDs will be reviewed with designated personnel at the affiliate clinical site. To be accepted for a clinical placement, all findings must be satisfactory to all participating clinical sites. Students not accepted for clinical rotations will not be able to successfully complete the course or program.

Students must be eligible to participate in all clinical sites affiliated with their particular program of study. Certain clinical sites have vaccine requirements, including the COVID-19 vaccine. Clinical sites can implement or modify vaccine requirements while a student is pursuing their studies and students will be required to comply with any updates in order to participate in clinical rotations and complete their program.

I understand that I must comply with the above requirements for a completed York Technical College Health Form, background checks, drug screens, and vaccine requirements as a student in the Health and Human Services programs.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student E-Signature

VERIFICATION OF RECEIPT – HHS APPLICATION PROCEDURES
In signing below, I understand that it is my responsibility to read and comprehend the information about applying, qualifying for, and entering my goal program which is available at http://www.yorktech.edu/departments/hhsd.

I also understand that it is my responsibility to contact a Program Representative, Admissions Counselor, or Advisor in the Academic & Career Advising Center for assistance should I have any questions regarding the information for the program and within this form.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student E- Signature
Should be Empty:

Surgical Technology

STATEMENT OF UNDERSTANDING REQUIREMENT FOR BACKGROUND CHECKS, DRUG SCREENS, AND VACCINES.

VERIFICATION OF RECEIPT – HHS APPLICATION PROCEDURES