Surgical Technology:
voice: 956.364.4805 voice: 800.852.8784
Department Chair:
Mailing Address: Surgical Technology TSTC Harlingen 1902 North Loop 499 Harlingen, TX 78550
Location: Located in the Sen. Eddie Lucio Health Science Technology Building Office number 192
Office Hours: M - F: 8:00 AM - 5:00 PM Sat., Sun.: Closed
Print Application
Date______________________ Interviewed: ___________ Accepted Date: ____________ Semester:_________________ |
APPLICATION FOR ADMISSION
Must be submitted in person
| Application Date:____________________Social Security:____________________
Last Name:______________First Name:_____________Middle Name:_________
Street Address:__________________P.O. Box:__________Phone:_____________ City:__________________County:__________State:_________Zip Code:_______
Have you been accepted for admission to Texas State Technical College? [ ] Yes [ ] No
EDUCATIONAL BACKGROUND:
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EMPLOYMENT HISTORY:
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PHYSICAL RECORD: List any physical or medical conditions that may need proper observation to prevent accidents or injuries to you.
_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
Do you hereby authorize your Doctor(s) to release record to this school and clinical site?
[ ]Yes [ ]No
Are you planning to apply for Financial Aid? [ ] Yes [ ] No
If yes, have you contacted and applied with Financial Aid Office located at the Student Services Building? [ ] Yes [ ]No |
I understand that the Admissions Committee will not regard this application as “complete” until all supporting documentation has been received; therefore, it is to my interest to see that these are submitted as promptly as possible. It is also my understanding that official transcripts sent directly from each school I have attended must be received by the Admissions Office as soon as possible at the end of each successive semester or semester for as long as my application is being considered.
I also understand that as a Surgical Technology student, I will be exposed to blood and body fluids. Texas State Technical College will not be held responsible for injury sustained during clinical experiences. As a student, I am required to carry my own medical and accident insurance. Proof of insurance, immunizations, and physical exam must be kept on file in the Surgical Technology Department and forwarded to the hospitals upon request. In addition, I also understand that as a Surgical Technology student, I will be required to obtain the Hepatitis B vaccinations.
The hospitals (clinical sites) have the right to approve or disapprove my application for clinical experience and may conduct a background check. Hospitals reserve the right to refuse clinical privileges to any student.
I further understand that the information submitted herein will be relied upon by officials of Texas State Technical College to determine my status for admission. I certify that the information in this application is complete and understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment, or appropriate disciplinary action.
Applicant’s Signature:_______________________________________________________ Date:_____________________ |
This completed application form must be submitted to: Texas State Technical College Surgical Technology Program C/O Eddie Lucio Health Science Technology Building 1902 North Loop 499 Harlingen TX 78550-3697  |