Model Health Education Program Application/Admission

Process Packet

High School Students

This packet is to be used as a guide in the development of your own admission policy for you technology center or school.

There are places that you need to add your schools information or specific requirements.

Recommended on February 20, 2004 by the Health Careers Education Division of the Oklahoma Department of Career and Technology Education. Contact Ruth Eckenstein at or Lara Skaggs at

Model Health Education Program Application/Admission

Process Packet

High School Students

January 2003

Step 1 / Instructions & Forms:
Pick up Application and Admission packet.
Admission Packet Includes:
  • Admission Requirements
  • Program Fact Sheet including Dress Code, Transportation, and Costs.
  • Deadlines For Each Step Of Process.
  • Application Form
  • Parental Consent Form
  • Information about Registration for Assessment
  • Letters Of References Forms
  • Supporting Documentation Forms
  • Essay Guidelines
  • Interview Process and Criteria/Rating Points

Step 2 / Registration for Assessment:
Register for admissions assessments or provide assessment results from alternative site. Minimal assessment should include achievement (TABE, COMPASS, ACT, ATI, etc.) and health aptitude (PSB-R, ATI, HOBET, etc.)
Step 3 / Assessment:
Complete required assessments and participate in interpretation of results
Step 4 / Application:
Submit completed application with current high school transcript or home schooling status attached. (See page
Step 5 / Letters of Reference:
Submit letters of reference from 3 current instructors. In the event that such references are not available, submit letters for reference from persons of responsibility who have observed you in a voluntary work situation or other like activity. DO NOT submit letters of reference from individuals who have no other qualification than friendship, kinship, social, or church affiliation. (See pages
Step 6 / Supporting Documentation:
Submit school activity forms, health related certification or other credentials or documentation of additional health related training. (See page
Step 7 / Essay:
Submit applicant essay. See page
Step 8 / Interview (if applicable):
If invited, attend interview for program selection. NOTE: Participation in the interview does not automatically grant acceptance into the program. All applicants will be ranked using the Criteria/Rating Points Form (See page )
Step 9 / Acceptance:
All applicants will be ranked using the Criteria/Rating Points Form (See page Admission committee will notify you of admission status by

Admission Requirements

Qualifications for Admissions:

A. Minimum criteria for admission are as follows:

  1. The successful completion through tenth grade or its equivalent.
  1. Dependability Superb attendance: No more than 5 absences during the application year and no more than 10 absences during the year immediately prior to the application year. (NOTE: Students with medically documented chronic/serious illnesses or other extenuating circumstances leading to excessive absences may be considered on a case-by-case basis. Such documentation must be provided at the time of application.)
  1. Excellent behavior: No suspensions during the application year and no suspensions during the year immediately prior to the application year.
  1. Scores at the fiftieth percentile or above on both the reading and mathematics components of the most current standardized academic measurements typically available (or their equivalents) for all interested students. (See attached list for acceptable tests)
  1. Grade point averages at or above 3.00 on a 4.00 scale for the first semester of the application year and for the year immediately preceding the application year.
  1. All Students – Must have (Each school should provide the specific information about prerequisites)

6.Completion of Application Process Packet

B. Admissions Process/Procedure:

After the above admission criterion is met the admission team using the attached Criteria/Rating Form shall rank acceptable applicants.

C. Waiting List:

Qualified applicants who are not admitted to the school or who are not admitted based upon lack of space available shall be placed on a waiting list.

Qualified applicants who decline an offer of admission to the school shall be placed on the waiting list.

The waiting list shall expire at a time and date to be established by the ______each year.

Program Fact Sheet including Dress Code, Transportation, and Costs

Deadlines For Admission Process Steps

Program Description / Dress Code /

Transportation

Each School should include program information here. / Each school should provide info on when the student will dress in uniforms. Appearance for field trips, etc / Each School should insert who will be responsible for student when attend clinicals
Clinical Experiences
Each school should provide the specific information about clinical. Such as attending during regular school hours. / Instruction Strategy
Each School should supply a brief description of how the course curriculum is presented. Traditional lecture or facilitated led instruction
Costs
Uniforms $90-120 /

Health Information

Each school should provide potential health risk associated with clinical.
Declaration of immunizations, exposure to hazards, such as body fluids, sharps, body mechanics injuries. Etc. / Other Information
Deadlines for Admission Process
Steps /
Process
/
Dates
Step 1 / Instructions & Forms:
Pick up application and instruction packet. /
August through March 31
Step 2 / Registration for Assessment: /
January and February
Step 3 / Assessment: /
February and March
Step 4 / Application including:
Parental Consent Form / April 1
Step 5 / Letters of Reference x 3
Step 6 / Supporting Documentation
Step 7 / Essay
Step 8 / Interview (if applicable): / May 1
Step 9 / Acceptance: / May 15

Application Form

(Each school should provide “Application Form” or see attached “Sample”)

Consent Form

Student Agreement:

I, the undersigned, acknowledge that I have requested the opportunity to be a student in the ______program at ______Technology Center. I understand that if accepted, I will be subject to certain rules and regulations concerning safety, the clinical facility, and general decorum and conduct. I also understand that this arrangement is by invitation and that the needs and plans of the Technology Center and the clinical facility where I am assigned may change or require termination of the arrangement at any time. I agree that I will follow the policies and procedures that are outlined in the student handbook, or I may be dismissed from the program and will have to return to my home high school for the rest of the school year.

Date ______Student Signature______

Parental and Student Consent Statement:

The undersigned (parent/guardian/s/ of the above named student understand, hereby consent and agree as follows:

1.Our son/daughter has been offered the opportunity to attend the ______Program at the ______Technology Center.

We understand that health care education program have experiences in laboratory and clinical environments that use scientific instrumentation, chemicals and biologicals when under ideal laboratory conditions may involve a degree of risk which is probably greater than ordinarily encountered in daily life and which certainly could involve greater risk if used improperly. We also understand that the laboratory and clinical personnel are mindful that they have special obligations and responsibilities to exercise care and attention in the instruction and supervision of our son/daughter and in excluding them form activities they believe to be inherently dangerous or inappropriate to their experience level.

Our son/daughter will be required to attend a laboratory and clinical safety instruction course and will be taught and/or supervised in the proper handling of such instrumentation and materials to minimize risk.

  1. We grant our permission to ______Technology Center’s representatives to provide such emergency care and treatments as in their judgment may be deemed necessary or advisable in the event that our child should require emergency care while acting in the course of his/her course work. We assume the cost of such emergency care and treatment, if any.
  2. We accept responsibility for any treatment or care required by our child beyond the emergency status, and understand that we shall be liable for all costs and charges incurred on his or her belief.

Date______

______

Signature of Parent/Guardian Signature of Parent/Guardian

Signature of Applicant - My signature above indicates that all information included in this application is correct and honest to the best of my knowledge.Information about Registration for Assessment

Registration for Assessment:

Register for admissions assessments or provide assessment results from alternative site. Minimal assessment should include achievement (TABE, COMPASS, ACT, ATI, etc.) and health aptitude (PSB-R, ATI, HOBET, etc.)

(Each School should provide information on where, when and how to how to get testing completed and submitted)

Letters of References Forms

Letters of Reference:

Submit letters of reference from 3 current instructors. In the event that such references are not available, submit letters for reference from persons of responsibility who have observed you in a voluntary work situation or other like activity. DO NOT submit letters of reference from individuals who have no other qualification than friendship, kinship, social, or church affiliation.

(See attached forms)

Essay Guidelines

An Essay is required as part of the application process. You may substitute a medical research or other scientific essay/paper if you are uninspired by the following question:

(Please type or print your response on 8.5 by 11 inch paper with you name at the top of each page)

Essay question: Please describe a recent medical, science or technology advance in health care. Would you like to be a part in utilization of this advance to provide better health care? Why or why not? Describe how you can play a role in supporting this new advance.

______Technology Center

1234 Lifelong Learning Rd

Everywhere, Ok 73000

LETTER OF REFERENCE

Applicant Name______Date______

(Please Print)

Release of Information: I give my permission to release information to ______Technology Center concerning my qualifications for entrance into a health-training program at ______

Technology Center, and I agree to hold blameless the person being requested to complete and return this form.

(Signature of Parent)(Signature of Applicant)

Confidential Response Form
Complete the following form based upon work association with the above applicant. Please complete all information requested below, or the reference will not be considered. Return reference form by faxing to the above number or mailing to the above address rather than returning to applicant. The reference is confidential and will be keep secured.
Please check the box that best describes the individual performance characteristics for each of the dimensions or traits listed. Thank you for you time and efforts.
Dimensions or Trait / Exceeds Standard / Meets Standard / Below Standard
Judgment and Problem Resolution
Tolerance for Stress
Teamwork
Communication Skills
Attention to Detail and Organization
Initiative
Appropriate Appearance and Demeanor
Graciously Accepts Criticism and Suggestions
Attendance and Punctuality
Additional Comments:

Individual Completing Reference:

Name______Title______

Position______Phone______

Mailing Address______

Thank you, again.

Supporting Documentation Form

Supporting Documentation:

Submit school activity forms, health related certification or other credentials or documentation of additional health related training. Complete the following form and submit with Application Forms

Applicant Name: Program Choice:

Interest:
Career Goals/Objectives:
Related Skills/Training:
Activities: Include activities you have done in school and non-school activities. / Officer
Clubs
Sports
Academic Clubs
Church
Community Involvement/
Volunteer Work
General Information: / Work:
Include copies of any awards, certificates or acknowledges as desired

Criteria/Rating Form

Applicant Name______Date Reviewed______

Competitive (Admission Packet complete and all required documentation had been received by deadline)

Noncompetitive (Admission Packet incomplete and required documentation not received by deadline)

Criteria / Rating Points Possible / Points Assigned
High School Transcript GPA / 3.0 – 3.9 / 3 pts
2.0 - 2.9 / 2 pts
1.0 -1.9 / 1 pt
Health Related Course / 1 high school credit / 1 point each
Health Related Certifications / Each / 1 point each
Program Goals (Health Care Related) / 1-3 points / 1-3 point
Learning Objectives / Identified objectives / 1 pt each up to 3 points
Activities / 1 each activity / 1 pt each up to 3 points
References / 1 each / 1 pt each up to 3 points
Essay / Appropriate responses to question / Up to 5 points
Assessment Scores / (Each school should set preferences) / Up to 3 points
Interview (If applicable) / Up to 5 points
Total Points

No single preference will be the sole determinant of whether a student is or is not accepted into the program.

Admission Committee Member______

Admission Committee Member______

Admission Committee Member______

Status of Student:

Accepted

Waiting List

Suggested to Try Again Next Year

Noncompetitive

Interview Process

Interview (if applicable):

If invited, attend interview for program selection. NOTE: Participation in the interview does not automatically grant acceptance into the program. All applicants will be ranked using the Criteria/Rating Points Form (See page

Each School can add their process for interview. It should include an outline of the process and how the student will be evaluated during the interview.

G:\HLTH\RUTH\Program Management\Admission Requirements\Model HS Health Education Program Admission Procedure.docCreated on 1/6/2003 9:47 AM

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