CCHCP Bridging the Gap Medical Interpreter Training Registration Information Program developed by: CCHCP-Cross Cultural Health Care Program, Seattle, WA Bridging the Gap (BTG): A Basic Training for Medical Interpreters The BTG course is a 40-hour professional development program that trains bilingual individuals to facilitate a medical encounter in the healthcare environment. The course covers: Basic interpreter skills: roles, ethics, conduit and clarifier interpreting, and managing the flow of the session. Information on health care: introduction to the health care system, anatomy, and basic medical procedures. Culture in interpreting: self-awareness, basic characteristics of specific cultures, traditional health care in specific communities, and culture brokering. Communication skills for advocacy: listening skills, communication styles, how doctors think, and appropriate advocacy. Professional development: effective communication, professional conduct, self-care, and resources for professional growth. Bridging the Gap Registration Pre-enrollment Information and Requirements: 1. All registration forms are accepted on a first come first serve basis. 2. Upon receipt of completed registration form with a $100 non-refundable deposit that covers language assessment and processing fees will reserve the applicant a seat in a scheduled course of their choice pending full payment and final confirmation. 3. All course participants must successfully complete a language proficiency assessment 30 days prior to taking the BTG course to ensure a seat in the course selected. Bridging the Gap Registration Enrollment Procedure: 1. After receipt of registration forms with $100 deposit an over the phone language proficiency assessment (LPA) will be scheduled at a time convenient for the course participant. 2. Upon successful completion of the LPA a confirmation letter will be sent and the balance of $350 will be due. 3. Balance of tuition fees must be paid in full 5 days prior to course start date with confirmation of selected course date from course participant. SECURITY NOTICE Indianapolis only: All participants in the BTG course must adhere to procedures for maintaining St.Vincent Health North building security. It is prohibited to prop open any doors to the St.Vincent Health North building for any amount of time. Open doors activate an alarm to security and cameras are used throughout the building to identify the individual. In the event that a BTG participant is in violation of these guidelines, St.Vincent Health/RUAH reserves the right to withdraw that candidate from the course immediately and such action would result in a forfeiture of all course tuition fees paid by the participant or on the participant’s behalf. Please assist us in maintaining the safety and security of all course participants and St.Vincent Health associates who are working in the building at all times. Cancellation Information: If you cancel your enrollment for a BTG course, all fees up to $350 (not including the non-refundable deposit of $100) will be credited to the applicant for enrollment in another BTG course date. If you wish to receive a refund of all paid fees up to $350, you must submit a written request to RUAH for the refund. Please allow 2-3 weeks for processing. Tuition: $450-Includes a non-refundable fee of $100 for language proficiency assessment and processing NO CASH will be accepted, all fees must be paid by Visa, MasterCard, check or money order. Please note: All courses are a total of 40 hours of training and are taught in English. Weekend and weekday courses are from 9 am to 5 pm each day. Attendance in all 40 hours of each course is required to successfully complete the training program. A final exam is given on the last day and requires a minimum passing score of 70% to complete the program. Final exam is administered in English. The course is limited to a maximum of 25 candidates per class. Weekend courses are Friday, Saturday, and Sunday 1st weekend, and Saturday and Sunday 2nd weekend A certificate of completion will be given to participants upon successful completion of the course. If you have additional questions, feel free to contact the RUAH office at 317-583-3216. Training Location: St. Vincent Health North Building 10330 N. Meridian Street, First Floor St. Vincent DePaul Room Indianapolis, IN 46290 Directions below From 465: • I-465 North to US-31 (Meridian Street) Exit. • North on Meridian Street (US 31) to 103rd Street. • Turn Left (West) on 103rd Street. • St. Vincent Health is located on the right (North) side. • Turn right at the first drive leading to the front visitor parking area. The main entry faces Meridian Street and is accessible to all visitors during normal business hours. From US 31 North: • South on US-31 / Meridian Street to 103rd Street. • Turn Right (West) on 103rd Street. • St. Vincent Health is located on the right (North) side. • Turn right at the first drive leading to the front visitor parking area. The main entry faces Meridian Street and is accessible to all visitors during normal business hours. For more information contact: RUAH by email: btg@stvincent.org phone: 317-583-3216 or Fax: 317-583-3250 Please retain these two pages of information for your records. Please read and sign course agreement form. revised.rdl.102912 BTG Medical Interpreter Training 2013 REGISTRATION FORM Please type or print, and complete one form per participant. Training schedule: Please mark your course preferences. Mark first choice as #1 and second choice as #2. Regular Weekend Courses: 1st week- Fri-Sun, 2nd week- Sat-Sun 9a-5p all course days Weekday Courses: Mon-Fri 9a-5p _________ May 6-10, 2013 ______ January 11-13 & Jan 19-20, 2013 _______ June 3-7, 2013 ______ February 8-10 & 16-17, 2013 _______August 5-9, 2013 ______ March 22-24 & 30-31, 2013 ______ April 19-21 & 27-28, 2013 ______ June 21-23 & June 29-30, 2013 ______ July 12-14 & 20-21, 2013 St. Vincent Anderson Regional Hospital _________ September 14-16 & 22-23, 2012 ______ September 13-15 & 21-22, 2013 ______October 11-13 & 19-20, 2013 ______November 8-10 & 19-20, 2013 Make payment by check, money order, MasterCard or Visa. Checks and money orders should be made payable to St. Vincent Health. If paying by credit card, complete the form below and sign. No Cash will be accepted. Participant information: Name ______________________________________Job Title____________________________________ Organization Name _________________________ Supervisor____________________________________ Home Address __________________________________________________________________________ City/State/Zip ___________________________________________________________________________ Home phone __________________ Cell phone __________________ Email _____________________ Primary Language _____________ Second Language _____________ Third Language _______________ To pay by credit card: Name ___________________________________ Credit Card Number ______-______-______-______ Address _________________________________ Expiration Date __________( on card) 3 digit code ____ (back) _________ Visa ________ MasterCard City/State/Zip ____________________________ Amount $___________ I authorize St. Vincent Health – RUAH to charge my credit card for payment of BTG fees. revised.rdl.102912 Date __________________ Signature ___________________________________ BTG Medical Interpreter Training COURSE AGREEMENT As a Bridging the Gap participant, I have read and agree to the following: 1. Bridging the Gap is a CCHCP Medical Interpreter training program, not a language course. I as a course participant am expected to be proficient in at least two languages, one being English. 2. An over the phone language proficiency assessment is required prior to the course to ensure language proficiency in two languages one of them being English. 3. I have read and understand the security notice and agree to adherence of all guidelines. Failure to comply may result in immediate dismissal from the course and forfeiture of all paid tuition fees. 4. I as a BTG participant must attend and complete all five scheduled course sessions from 9a-5p. 5. The course day begins promptly at 9:00 am, each day will be complete at 5:00 pm. 6. I understand a final exam score of 70% or higher is required to successfully complete the course. If I do not pass a make-up exam score of 75% or higher is required to successfully complete the make up exam. 7. I understand St.Vincent Health/RUAH reserves the right to cancel any scheduled course at any time. In the event a course is cancelled all fees except the $100 deposit will be refunded or credited to another scheduled course of my choosing. I have read and agree to the above: Signed ________________________________________ Date: _____/_____/_____ Printed Name ________________________________________________ Mail your completed registration form, signed course agreement, and payment to: St. Vincent Health – RUAH Bridging the Gap Program 10330 N. Meridian Street, Suite 415 Indianapolis, IN 46290 Or FAX: 317-583-3250 Checklist: Completed registration form Signed course agreement Payment NO CASH, must pay with credit card, check, or money order. OFFICE USE ONLY Registration form and non-refundable deposit revised.rdl.102912 Completed Language Proficiency Confirmation and payment of BTG course BTG Final Exam Score Certificate of Completion Issued