Associate of Science in Surgical Technology
SURGICAL TECHNOLOGY
PROGRAM APPLICATION
PACKET
INCOMPLETE OR
LATE APPLICATIONS
WILL NOT BE ACCEPTED
Application
Deadline is March 15, 2016 @ 5:00 pm
RETURN COMPLETED APPLICATION IN PERSON TO:
DIVISION OF NURSING AND ALLIED HEALTH
555 Julia Street
BATON ROUGE, LOUISIANA 70802
Applications returned through the mail will not be accepted
For additional information please contact:
DIVISION OF NURSING AND ALLIED HEALTH
PHONE: (225) 216-8044
It is the policy of Baton Rouge Community College not to discriminate on the basis of age, sex, race, color, religion,
national origin or disability in its educational programs, activities or employment policies.
PROGRAM INFORMATION
Graduation from Baton Rouge Community College (BRCC) Associate of Science in Surgical Technology Program
provides students with the necessary knowledge, skills, values and competencies for a career in surgical technology. The
surgical technologist completes a comprehensive education in which they receive in-depth knowledge related to the
operating room including completion of a surgical rotation. The surgical technologist learns in detail the principles of
asepsis and application of sterile technique during surgical procedures. They are educated as subject matter experts
(SME) in the principles of asepsis and application of sterile technique. As SMEs, the surgical technologist can provide
recommendation to various healthcare providers in regard to properly apply sterile technique during invasive procedures.
Surgical technologist work successfully in any area where a high level of knowledge of sterile technique and surgical
products is required. They fill roles in the operating room across multiple specialties as well as central supply and
purchasing, where they assist in evaluating many surgical products, as well as representatives for medical product
companies where their experience helps facilities knowledgeably select products to accommodate their surgical needs.
The Associate of Science in Surgical Technology Degree also provides the graduate with an educational foundation for
transition into the university setting.
In order to be eligible for admission to the Department of Allied Health’s Surgical Technology Program, the applicant must
first be admitted to Baton Rouge Community College (BRCC). The College application is available from the Office of
Enrollment Services, or online at http://www.mybrcc.edu. The Surgical Technology Program application and all supporting
documents must be received by the designated deadlines. Applicants will not be considered for admittance to the
Surgical Technology Program until all required documents have been submitted and the applicant’s file is
complete. A copy of the application and all supporting documents should be retained by the applicant since the Division
of Nursing and Allied Health will not return the original application or any supporting documents. All correspondence will
be sent to the applicant’s permanent address. Admission to the Surgical Technology Program is competitive and will be
based on the following criteria: 1) Cumulative GPA, 2) GPA in 30 credit hours of required courses, 3) Earned grade in
SURT 102, 4) Earned grade in SURT 102L, 5) Ability to comply with the Surgical Technology Program Core Performance
Standards for Admission and Progression and 6) number of required courses completed with a grade of "C" or higher at
BRCC. It is important to note that simply meeting requirements for admission to the surgical technology program
does not guarantee admission.
APPLICATION PROCESS
STEP 1 BATON ROUGE COMMUNITY COLLEGE ADMISSION REQUIREMENTS-In order to be considered for
admission to the Surgical Technology Program you must be admitted to Baton Rouge Community College. If you
are not already a BRCC student you must complete and meet the BRCC admission requirements. If you need
assistance contact the Enrollment Services Office in the Bienvenue Student Center or call 225-216-8000.
STEP 2 SURGICAL TECHNOLOGY PROGRAM ADMISSION REQUIREMENTS
1. Must have completed and met the BRCC admission requirements
2. Applicant must have a GPA of 2.5 or higher in the following 30 credit hours of courses
3. Applicant must have a grade of “C” or higher in the following 30 credit hours of courses
Prerequisite Courses
ENGL 101
English Composition I
ENGL 102
English Composition II
MATH 101/110
College Algebra
BIOL 230
Human Anatomy and Physiology I
BIOL 231
Human Anatomy and Physiology II
BIOL 210
General Microbiology
HLSC 101
Introduction to Health Professions
HLSC 110
Medical Terminology
SURT 102
Surgical Technology Fundamentals
SURT 102L
Skills Lab I Surgical Technology
4.
Credit Hours
3
3
3
4
4
4
2
3
3
1
Applicants must submit a copy of their official transcript with their application.
Submit completed and signed Surgical Technology Applications to the Nursing Department in person by
March 15, 2016.
Applications are not to be returned in the mail to the Nursing Department
STEP 3 SELECTION NOTIFICATIONS
1. All applicants will receive a preliminary notification (Eligible for Admittance or Not Eligible for Admittance).
2. Students Eligible for Admittance to the Surgical Technology program will receive additional instructions
regarding the following requirements before granted admission to the program, which include but may not be
limited to:
 submission of personal health history, results of a physical examination, various
immunizations/vaccinations,
 TB skin test
 CPR certification
 Criminal background check
 Urine drug screen
A positive urine drug screen or any attempt to tamper with the specimen will disqualify an applicant and/or
result in dismissal from the Surgical Technology program.
3. Costs for all requirements are borne by the student.
4. Final Admission to the Surgical Technology Program is dependent on:
 Successful completion of prerequisites
 Results of physical exam
 Results of urine drug screen
 Results of criminal background check
5. Applicants Eligible for Admittance will receive a final notification of eligible admittance to the surgical
technology program (accepted or denied).
6. Students who accept the offer for admission must return a conformation letter to Division of Nursing and
Allied Health accepting entry into the Surgical Technology Program and attend a MANDATORY PreAdmission Surgical Technology Program Orientation Session date, time, and location to be announced.
RETURN COMPLETED APPLICATION IN PERSON TO:
DIVISION of Nursing/Allied Health
555 Julia Street
Baton Rouge, LA. 70802
(225) 216-8044
OFFICE USE ONLY
SUBMISSION DATE:____________
Do Not Mail
TIME: _________________
DEADLINE
3/15/2016 @ 5 pm
INCOMPLETE OR LATE APPLICATIONS
WILL NOT BE ACCEPTED AND THE APPLICATION
PERIOD WILL NOT BE EXTENDED
SURGICAL TECHNOLOGY APPLICATION
You must print & complete this application page
INDICATE STATUS
APPLICATION REQUIREMENTS
Applicant must have a GPA of 2.5 or higher in the following 30 credit hours of courses
Applicant must have a grade of “C” or higher in the following 30 credit hours of
courses
Complete /
Complete /
Complete /
Complete /
Complete /
Complete /
Complete /
Complete /
Complete /
In-progress
In-progress
In-progress
In-progress
In-progress
In-progress
In-progress
In-progress
In-progress
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ENGL 101- English Composition I (3 credit hours)
ENGL 102- English Composition II (3 credit hours)
MATH 101 or 110-College Algebra (3 credit hours)
BIOL 230-Human & Anatomy Physiology I (3 cr lec; 1 cr lab)
BIOL 231-Human & Anatomy Physiology II (3 cr lec; 1 cr lab)
BIOL 210- General Microbiology (3 cr lec; 1 cr lab)
HLSC 101- Introduction to Health Professions (2 credit hours)
HLS 110 – Medical Terminology (3 credit hours)
SURT 102 - Surgical Technology Fundamentals (3 credit hours)
SURT 102L – Surgical Technology Skills Lab 1
List name(s) of school(s) attended:
.
.
.
.
.
PERSONAL INFORMATION
Last Name
First Name
Middle Name
Mailing Address
City / State
Home Phone Number
(
)
E-Mail Address
Cell Phone Number
(
)
Student ID Number
ADDITIONAL INFORMATION
Are you a licensed / certified allied health care
provider?
Do
you have additional
❏ Yes
❏ No post-secondary degrees?
❏ Yes
❏ No
Zip Code
Please list type of licenses or certifications
Please list additional degrees earned
I would like to apply for admission to the surgical technology program. I understand that submitting this
application does not guarantee acceptance into the program. And that any attempt on my part to falsify or
exclude information is cause for disqualification of my application and / or dismissal from the surgical technology
program. I hereby certify that all information presented is true to the best of my knowledge.
Student Signature
Received by
Date
Date
.
Time
.